Advancement genioplasty: a retrospective cephalometric analysis of osseous and soft tissue changes.

Serial cephalometric evaluations were made of 15 patients a year after advancement genioplasty to assess skeletal changes, to relate these changes to net soft tissue profile change, and to develop predictive criteria for treatment planning. Coefficients of variance of regression equations, which incorporated selected independent variables, indicated that the variables, interval of time until follow-up records, and the extent of postsurgical horizontal resorption contributed only slightly to the observed variance in prominence of the soft tissue chin. For purposes of prediction, a ratio of 4:3 is recommended for the surgical horizontal advancement of the symphysis versus the net horizontal change in soft tissue chin point.


Applicants' opinions about the selection process for oral surgery programs.

A survey of applicants to oral surgery graduate programs was distributed to 170 candidates requesting application forms from the University of Kentucky. Eighty-five applicants responded. The average candidate was approximately 28 years old, married, and attended dental school in the southeast or midwest. He applied to ten programs and viewed a personal interview as an important part of the application process. Traditional criteria such as basic science grades and class rank were not uniformly considered as important factors in the initial screening of candidates. Other views and criticisms of the applicants are examined and suggestions are provided to reduce some of the apparent inequities now inherent to the system.


The Ramsay Hunt syndrome: a dynamic demonstration of applied anatomy.

The clinical features of herpes zoster of the geniculate ganglion were reviewed and related to the functional anatomy of the seventh cranial nerve. An illustrative case highlights many of the features of the syndrome that was first described by Ramsay Hunt. The significance of facial palsy is discussed in the light of its distribution.


Peripheral ameloblastoma: report of case and review of the literature.

A case of an extraosseous ameloblastoma occurring in a 33-year-old woman has been described. Of the 11 cases documented in the literature, only nine fulfill the histologic and clinical criteria for a true peripheral ameloblastoma. In contrast to the intraosseous ameloblastoma, the diagnosis of extramedullary or peripheral ameloblastoma implies a less aggressive neoplasm that can be treated by a more conservative surgical approach.


Hemangioendothelioma of the mandible: report of case.

A case of hemangioendothelioma of the mandible, the third of its kind to involve the jawbone is reported. The radiological appearance of new bone formation is a unique feature in this case. The vascular malignant tumor has a poor prognosis.


Synovial chondrometaplasia of the temporomandibular joint: report of case.

A case of synovial chondrometaplasia of the temporomandibular joint is presented with a discussion of the pathologic findings, diagnosis, and treatment. This is a highly uncommon, benign lesion of this joint that affects women more often than men. Since the histologic appearance of some of the tissue cells may resemble malignant changes, care should be taken not to confuse this condition with chondrosarcoma.


Transmedullary amputation and resection of metastases in combined therapy of osteosarcoma.

The eradication of microfoci of metastatic osteosarcoma by adjuvant chemotherapy permits the surgeon to take a more conservative approach to amputation and to more aggressively resect metastases. In a series of 59 children with osteosarcoma of an extremity, transmedullary amputation carried no greater risk of stump recurrence than either disarticulation or amputation above the joint. We attribute this to careful selection of the level of amputation by use of preoperative bone scans, intraoperative frozen sections of bone stump and intensive postoperative adjuvant chemotherapy. Immediate application of a prosthetic limb has enhanced the physical and emotional rehabilitation of these patients. Resections of pulmonary metastases in 12 patients who were receiving adjuvant chemotherapy has resulted in a median tumor-free survival of 17 mo, with 3 patients still alive without disease for 13, 25, and 72 mo. A more aggressive approach to the resection of pulmonary metastases may substantially improve current rates of tumor-free survival.


Acute lymphoblastic leukemia diagnosed by renal biopsy.

An 8-year-old boy who presented with recurrent attacks of acute non-oliguric renal failure is described. Hemograms were normal and the kidneys were not enlarged. A renal biopsy was done and diagnosis was acute lymphoblastic leukemia. The etiology of renal failure in leukemia is discussed.


Mumps uveitis complicating the course of acute leukemia.

A case of a nine-year-old child with acute lymphocytic leukemia in remission who developed infectious parotitis with uveitis was presented. Ocular complications of mumps have been briefly discussed and the differential diagnosis particularly in relationship to leukemia have been emphasized. The significance of depressed cellular immunity in the development of this complication was entertained.


Carcinoembryonic antigen in osteosarcoma.

Plasma carcinoembryonic antigen (CEA) assay was done in 30 patients with osteosarcoma. CEA was found positive (greater 2.5 ng/ml) in 17 of 21 patients who had active evidence of disease and negative (less than 2.5 ng/ml) in all 9 patients who were in complete remission resulting from previous amputation of chemotherapy. Serial CEA determinations demonstrated a fall to normal in 7 of 9 patients following successful surgery of chemotherapy and a ruse and fall (fluctuation) of levels in 8 patients who had tumor progression while on chemotherapy. Clinical recurrence of disease in two instances preceded or coincied with CEA elevation. The CEA assay in osteosarcoma although non-specific could be used as an inportant adjunct to experienced clinical judgment, periodic x-ray examination, and laboratory study to prognosticate the course of osteosarcoma during therapy. The interpretation of a rising or falling CEA titer alone, however, must be made with caution.


Periostitis of the mandible. A case report and review of the literature.

Periostitis of the mandible has not been previously discussed in the otolaryngologic literature and only infrequently in the dental literature. It is characterized by a hard, painless, fixed mass overlying the mandible in a child or young adult. The etiology is usually an endosteal infection in the molar region with periosteal inflammation. Reactive new bone is deposited beneath the elevated periosteum, external to the outer cortex of the jaw, and separated from it by a layer of suppurative fluid. Treatment consists of removal of involved teeth and infected bone, drainage of the fluid pocked and appropriate antibiotics. Patients are followed with repeat X-rays and erythrocyte sedimentation rates. A case is presented and the world literature is reviewed. The otolaryngologist should be aware of this entity and include it in the differential diagnosis of any fixed jaw mass to avoid mistaking it for a more malignant process with unfortunate consequences.


Conservative treatment of retinoblastoma.

42 cases of retinoblastoma were treated by light coagulation with or without radiotherapy and chemotherapy. 29 cases were cured (69%). The follow-up time of these cases amounts between 3 and more than 16 years.


Leukoencephalopathy in childhood leukemia.

A 14-year-old boy survived for 7 years after the initial diagnosis and treatment of acute lymphocytic leukemia. Neurologic deterioration occured repeatedly throughout his complicated clinical course but it was most severe and only partially reversible following orally administered pyrimethamine. The neuropathologic lesions were distinctive and included a diffuse reactive astrocytosis, axonal degeneration, status spongiosis, circumscribed foci of demyelination and coagulative necrosis, and mural thickening with luminal narrowing of microcirculatory vessels. This collection of findings represents the leukoencephalopathy of childhood leukemia that we and others believe results in large part from the combined effects of cranial irradiation and chemotherapy. The role of folic acid antagonists, namely methotrexate and pyrimethamine, are particularly noteworthy in this regard.


Measles pneumonia in childhood leukemia.

Fatal measles pneumonia developed in a 7-year-old boy who was in complete remission from acute lymphoblastic leukemia. There was no detectable antibody titer in two specimens taken eight days apart. Measles virus was grown from a lung biopsy taken shortely after hospital admission. Classical measles had been diagnosed in the patient and his siblings nine months previously. Immunosuppressed children who do not develop an antibody rise after a measles infection are at risk of later development of measles giant cell pneumonia. Suggestions are offered for the prevention of this often fatal complication.


[Study of the labor market for dentists who recieved Norwegian authorization during 1972-1975. I. Waiting time and alternative employment before the 1st relevant job].

The purpose of the investigation was to monitor changes in the labour market situation for dentists who received authorization to practise dentistry in Norway during the years 1972-1975. Data was collected by postal questionnaire during April/May of the year following authorization, except for the 1972 cohort, which was contacted the second year after authorization. A 92-95 per cent response rate was achieved using one follow-up (Table 1). The percentage of respondents who waited 8 weeks or more to acquire a job in dentistry increased from 15 for those authorized in 1972 to 36 for the 1975 group (Table 3). The proportion of dentists who took paid employment other than dentistry, increased from just over 3 per cent for the 1973 to 14 per cent for the 1975 cohort (Table 4). This development has occured despite a decrease in the number of dentists receiving authorization each year and has resulted in a limited emigration of dentists. It is suggested that the favourable supply of dentists in relation to existing demand for dental services presents an ideal opportunity for attempting to solve dental health problems which have received inadequate attention in the past.


[Seamen and dental health. Studies of tooth status among naval staff and merchant seamen. A review].

Dental health among Norwegian seamen, based on clinical examinations (Table 2) and interviews have been studied. Interview findings from eight ships in overseas trade indicated that the occupational conditions of seafarers caused irregular use of dental services (Table 3) and poor dental health compared with that of the general population. In an epidemiological survey comprising 431 Norwegian seamen in overseas trade, these indications were supported (Table 1 and Table 2). Approximately every fifth of the male seafarers aged 20 years or more had visited the dentist annually during the last five years. In a subsample of 212 subjects who were examined both clinically and radiographically, the number of decayed teeth averaged 6.1. It is concluded that regular dental check-up as well as delivery of dental services should be provided through the established health centers for seamen.


Lysozyme: a brief review.

Serum lysozyme (muramidase) estimation is a simple, convenient and useful laboratory investigation. A review of the literature shows that lysozyme has been implicated as an aetiological factor in various disorders, and credited with being a prognostic indicator in acute myeloid leukaemia, but these promises have not been fulfilled. This low molecular weight protein is found in the urine of some patients with renal tubular disorders, but some workers have emphasized its importance as a causal agent in hypokalaemia of acute myeloid leukaemia. Research should be concentrated on muramidase as an expression of cell functions rather than as an aetiological factor. Hypokalaemia in acute myeloid leukaemia may be caused by an unidentified substance of molecular weight similar to that of lysozyme.


Portal hypertension in a patient with chronic myeloid leukaemia.

A patient with chronic myeloid leukaemia treated with busulphan for 4-5 years, developed signs of busulphan toxicity and portal hypertension with ascites, oesophageal varices and jaundice. At post-mortem there was minimal leukaemic infiltration but there were alterations in the liver architecture sufficient to explain the portal hypertension. The pathogenesis of the liver changes and their possible relationship to splenomegaly and busulphan toxicity are considered.


Side effects of antihemophilic concentrates.

Liver disease and thromboembolism are the most frequent and severe side effects associated with the use of clotting-factor concentrates in haemophiliacs. Knowledge and careful evaluation of the risk factors related to their development appear to be the most reasonable policy for prevention. themolysis due to significant isoantibody infusion and bleeding associated to abnormal platelet function occur more rarely during intensive replacement therapy with clotting factor concentrates. Finally, abnormalities of renal function have been observed in a number of patients, though they seem to be of minor clinical importance. These complications do not justify withdrawal or limitation of the very effective and life-changing use of concentrates. However, awareness of their occurrence and of their danger requires that specialized hemophilia centres carry out, at frequent intervals, clinical and laboratory testing of the target organs to allow an early detection.


Jaundice and hepatitis B surface antigen and antibody in Greek haemophiliacs.

The incidence of hepatitis B surface antigen (HBsAg) and antibody (HBsAb) in 101 Greek multitransfused haemophiliacs with or without a previous history of jaundice was studied. Using the haemagglutination inhibition assay, HbsAg was detected in 9.9%, HBsAb in 61.3% and HBsAg plus Ab in 11.8% of the cases. The incidence of jaundice was 14.8%. Liver function was tested by means of Normotest, SGOT, SGPT and serum protein electrophoresis. Abnormal values of liver function tests were found in 47% of the patients. The abnormal findings were related to the presence of HBsAg or Ab and to the history of jaundice. There was no significant difference between the various groups of patients.


Modifications of factor VIII related antigen in hemophiliacs with acute hepatitis and sub-clinical liver disease.

Modifications of Factor VIII related antigen (F, VIII R. A.) were investigated in three hemophilic patients during the course of post transfusion hepatitis. F. VIII R. A. was found to be elevated and correlated with the increase of the S.G.P.T. During the acute phase of the disease the Factor VIII related protein was tested for its ristocetin cofactor activity, its electrophoretic mobility on crossed antigen-antibody electrophoresis and its elution pattern on Sepharose 4B columns; all these properties proved to be abnormal. Liver function tests and F. VIII R. A. were measured in 36 multitransfused hemophiliacs. There was a significant increase of the F. VIII R. A. in the plasma of patients with abnormal liver function tests. Only a few of the multitransfused hemophiliacs had clinical symptoms of hepatitis, although 72% had elevated transaminase levels.


Chronic hepatitis in hemophilia.

The relationship of chronic hepatitis B and/or liver dysfunction to treatment in 113 hemophiliacs was evaluated by the enzyme tests, SGOT and SGPT, and by the presence of circulating hepatis B surface antigen (HbsAg) or antibody (anti-Hbs). The hemophiliacs were divided into three groups according to treatment pattern. Individuals who had received multiple doses of plasma fractions, derived from four or more commercial lots were placed in tgroup I "large Exposure". Group II "Small Exposure" had been treated with fractions from three or fewer lots and Group III "Cryo" had never received commercial fractions, but had been treated with cryoprecipitate. Abnormal liver function tests (LFT's) were found in 87% of Group I and 76% of Group II, but in only 16% of the "Cryo" group. Differences in LFT's were not great between treated VIII and IX deficient patients. All patients treated with 100,000 units or more showed either persistent or intermittent abnormalities. In the high exposure group, this history of past, overt hepatitis had no influence on observed LFT's. The sera of all patients in the high exposure and all, except one, in the low exposure groups were positive for HbsAg or anti-Hbs by RIA. Splenomegaly was found in 13% of fraction-treated patients. We conclude that there is biochemical evidence of liver disease following large exposure to commercial VIII or IX fractions, which should temper the physician's decision to start treatment with these fractions. On the other hand, evidence that their continued use produces mounting liver dysfunction is insufficient to withdraw this very effective and life-changing treatment from these individuals.


Alteration of primary hemostasis in hemophiliacs after treatment with lyophilized antihemophilic globulin.

Seven patients with classic hemophilia A had alteration of primary hemostasis after treatment with lyophilized antihemophilic globulin (LAHG). The following test results, which were normal before treatment, became abnormal after treatment: bleeding time, bleeding intensity, and platelet adhesiveness. In two patients, the fibrin-fibrinogen-degradation products increased to more than 40 microgram/ml. In three patients, the bleeding symptoms became worse with LAHG therapy although no inhibitor against Factor VIII was demonstrated. In one of these patients, the bleedings symptoms disappeared when the use of LAHG was discontinued and prednisone was given; at the same time, the altered primary hemostasis returned to normal. In the remaining two patients, prednisone did not have any effect. In these two patients, however, the bleeding stopped, and the bleeding time became normal immediately after freshly prepared blood-group compatible cryoprecipitate was given.


Factor IX and thrombosis.

Fractionation technology has made Factor IX concentrates available. In addition to a very high incidence of hepatitis, thrombosis is being recognized as a consequence of their use. Contradictory reports exist in the literature as to the incidence of thrombotic events. A recent study of thrombohemorrhagic phenomena after infusion with Factor IX concentrates in patients with congenital Factor IX deficiency (hemophilia B) or liver disease, revealed an incidence of twenty episodes in 188 cases (11%). It is imperative to delineate the thrombogenic factors and find methods for their removal to insure the safety of Factor IX products.


Renal disorders in haemophilia A and B.

Although haematuria is a relatively common symptom of hemophilia A and B, renal disease seemed to be a rarity and it has usually been held that this symptom was benign in nature. However detailed studies of renal function in a series of such patients using radiological and biochemical tests of renal function show significant differences compared to normal. These abnormalities seem to be associated with recurrent haematuria but do not appear to be related directly to replacement therapy with plasma concentrate and do not occur more frequently in patients who have received long term fibrinolytic inhibitors. Other rare renal disorders associated with haemophilia include nephrotic syndrome, trauma, acute tubular necrosis, analgesic nephropathy and chronic pyelonephritis.


Isoimmunization in haemophiliacs.

Serum samples from 134 Greek haemophiliacs multitransfused with fresh frozen plasma and factor--VIII or factor--IX concentrates were investigated for the presence of blood group antibodies. All samples were tested against a panel of selected cells of known but differing genotype. The incidence of blood group antibodies was 12.7%. Anti-D was found in 6 out of the 17 immunized patients, i.e., 35.3% of D-negative haemophiliacs were sensitized. It is concluded that the high incidence of immunization is a serious complication of repeated plasma transfusions.


Home care for hemophilia: current state of the art.

While home care treatment for hemophilia is not a panacea and does not supplant good comprehensive care, it does seem to offer improved medical care for those hemophiliacs enrolled in such a program. The results have been very encouraging in the programs of this type throughout the United States. Since most programs have been in existence for 5 years or less, long-term data have not accumulated. However, the evidence seems to suggest that crippling is less in children and that orthopedic deformities do not progress at the same rate in adults. Children have improved school attendance; young men may attend college and graduate schools without difficulty. Adults may hold a job without fear of absenteeism. There are fewer dollar costs of the disease for the patient and the psychiatric cost of this chronic illness is markedly less. The quality of life is improved and the patient may develop a new self-confidence which allows him to function as a productive member of society.


Liver dysfunction in patients with hemophilia.

The incidence of post-transfusion hepatitis and liver dysfunction is presented in fifty-four patients with classical hemophilia who received episodic and/or prophylactic Factor VIII concentrate. 42.5% had persistent biochemical evidence of liver dysfunction with elevated SGOT and SGPT; 3.8% have persistent (HBs) antigenicity and 90% have (HBsAb) antibodies. The results are the same for those who were treated episodically and received an average of 753 units Factor VIII per week as those treated prophylactically who received an average of 686 Factor VIII units per week. The incidence of clinical and/or subclinical disease is unaffected by the transfusion regimen or the amount of concentrate used. The necessity for close follow is emphasized for determination of chronic liver disease and its further therapy.


Projected estimation of factor VIII requirements for home treatment based on a pilot study of two haemophilic patients.

An extensive programme of home administration of factor VIII replacement therapy has been proposed for the haemophiliacs of the Edinburgh Area following the successful training of self-administration therapy in the Haemophilia Centre. A study of 1 moderate and 1 severe haemophiliac, whose factor VIII requirements for the year 1974 were compared with factor VIII usage for "on demand" out-patient therapy at the Centre in 1973, showed these quantities to be 14,380 as compared with 38,725 factor VIII units in the severely affected patient. From these figures, and, knowing that the average number of factor VIII units used per patient per years was 8,116 for the moderate and 11,592 for the severe haemophiliacs, it has been calculated that home treatment would require 6,000-10,000 factor VIII units per patient per year for the latter class. The advantages and hazards of home treatment are discussed and evaluated in the light of the two patients studied and the self-administration programme of therapy at present in operation.


Increase of proliferative activity of leukaemic blast cells from human peripheral blood in liquid culture.

The proliferative behaviour of leukaemic cells from the peripheral blood of 12 patients suffering from acute leukaemia was investigated in short term liquid culture. In 3 cases of AML an increase of the blast cell number was observed exceeding the initial value whereas in 9 other cases the cell number decreased more or less rapidly. In 9 of these patients the proliferation kinetics of the cultured leukaemic blast cells were studied with 3H-thymidine labelling. In all these cases the labelling index increased during the first days of culture, in 3 cases to values of 48%, 45% and 38% on day 3. Only in 5 cases, however, did an absolute increase of the blast cells incorporating 3H-thymidine occur. Here the doubling times of the proliferating leukaemic blast cells were estimated to be 12, 13, 14, 28 and 55 h. Since a doubling time of 12 to 14 h seems to be too short to be explained only by an exponential growth of the initially proliferating cells it is postulated that leukaemic blast cells in a G0- or long G1-phase were present in the peripheral blood of these patients and that these entered the cell cycle during liquid culture.


[Portal hypertension without liver cirrhosis in chronic vitamin A intoxication].

The ysmptoms and findings in a patient after prolonged intake of excessive amounts of vitamin A for treatment of psoriasis are presentd. All the characteristic signs of chronic intoxication were reversible after withdrawal of the medication. Initially portal hypertension could be demonstrated, although histologically there was no cirrhosis of the liver. During the period of observation the disturbed liver function returned to normal and the signs of portal hypertension disappeared completely. Reversibility of portal hypertension is a unusual observation and is discussed in relation to similar situations in toxic liver disease.


[Comparative testing of various resins for model dies].

The value of resins for model dies is controversial. This objective study indicates that epoxy- and epimine resins may be successfully used as die materials, if certain measures are taken as a precaution. The resin should be centrifuged and a slight contraction of the material must be calculated into the chain of manufacture. The material should not be poured into hydrocolloid impressions, as the humidity of this impression material may interfere with the proper polymerization of the resin. A major inconvenience are the frequent formation of air bubbles on the angles of the preparation, and this in spite of the use of the vibrator.


[Comparative clinical and histological studies on extraction wounds with and without local application of a salicylic acid preparation (Apernyl)].

Selected patients with extraction wounds served to experiment with Apernyl-styli of Bayer. Contralateral alveoli were used as controls. 10 days following operation biopsies were taken from treated and untreated alveoli. Histologically, a morphometric study was made, and clinically healing was judged by the frequency of complications and the initial physiologic pain. The results show that Apernyl does not influence histological healing, positively or negatively. Thus, the results obtained by Nordenram and Band (1970) and Satoh et al. (1973) could be confirmed. Clinically, there were significanlty less p.o. complications in patients with Apernyl prophylaxis; 2 of 51 treated alveoli compared to 8 of 45 untreated ones. Pain was significantly reduced: 17 of the 19 patients complained of pain in the untreated half of the jaw, while only 4 suffered pain on the treated side. This confirms the findings of Neuner and Panzera and Neuner and Schegg (1972 and 1969 resp.).


[Expansion of the scope of indications for Wirz' transfixation method].

Transfixation after Wirz, a closed implantation, serves to conserve periodontally weakened teeth. The method can be recommended to the practitioner. It is subdivised into 6 phases which are described. The treatment method may be successfully enlarged clinically and topographically. 7 cases are demonstrated and show the scope of indication.


[Caries diagnosis of deciduous teeth, value of radiography].

Deciduous molars of 10-11 year-old children were examined clinically and radiologically for caries. The findings were compared. Without the radiological evidence of the bitewing pictures about 66% of proximal caries of deciduous molars would have been overlooked. Moreover, the lesions could be detected earlier.


[Interpretation and misinterpretation in occlusion diagnostic radiography of the temporomandibular joint].

Methodical procedure is of considerable importance in interpreting radiographs of the temporomandibular joint. Under this aspect the technique used at the Dental School of the University of Zurich, Department of Prosthodontics, is described. Two principal steps are distinguished for the evaluation of a radiograph: valuation and interpretation. In order to make clear radiographic anatomy and characteristics of projection of the joint region two didactic models are introduced. Problems, limits and pitfalls in interpreting radiographs of the temporomandibular joint in oblique lateral projection are shown.


[Porosity of composite filling materials].

The porosity of composite materials was investigated. For the 5 materials tested the values varied between 5.9 and 2.2 vol. %. The volume of porosity could be reduced markedly by a short application of pressure upon the mixed material. Pressure and time of pressure were checked separately, and it could be shown that the percentage of porosity reduction was correlated almost completely with the viscosity of the composite.


[A modified set of instruments for percutaneous screwing together of mandibular fragments].

A modified instrumentation for the percutaneous screwing of mandibular fragments is presented. Functionally stable osteosynthesis in the mandible may be obtained by the tractional screws and osteosynthesis plate (DCP, EDCP). It is possible to use the 2-mm miniscrew and also the 2.7- and 3.5-mm corticalis screw. Thus, it seems possible to use percutaneous, functionally stable osteosynthesis with plates and screws for certain types of fractures and corrective osteotomies of the mandible. In addition, the same technique applies to the sagittal splitting of the ascending ramus after Obwegeser for the correction of mandibular prognathism.


[15 year's results with combined caries prophylaxis according to the recommendations of the seminar for juvenile dental health (1961)].

Consistent combination of the prophylaxis measures as recommended by the Seminar for youth dental health has led to a 67% decrease in caries incidence for the Bettlach schoolchildren, during the last 15 years. A very important factor is the good collaboration between school dentists and teaching staff of the school; centralized examination makes thorough and universal prophylactic measures possible.


Oscillation and chaos in physiological control systems.

First-order nonlinear differential-delay equations describing physiological control systems are studied. The equations display a broad diversity of dynamical behavior including limit cycle oscillations, with a variety of wave forms, and apparently aperiodic or "chaotic" solutions. These results are discussed in relation to dynamical respiratory and hematopoietic diseases.


Inducibility of transferrin receptors on friend erythroleukemic cells.

The ability of Friend erythroleukemic cells to bind transferrin and take up its iron increases substantially as a result of dimethyl sulfoxide-stimulated differentiation. Although transferrin-binding activity is also demonstrable in another mouse cell line of hematopoietic origin, the lymphoma cell, it does not increase on exposure to dimethyl sulfoxide. Gel filtration studies corroborate that the binding of transferrin to the erythroleukemic cells is due to the formation of a specific complex of transferrin and a membrane receptor. Thus, the specific interaction of transferrin with its receptor is another expression of dimethyl sulfoxide-induced differentiation in the Friend cell.


Host control of tumor growth.

A humoral factor (molecular weight less than 60,000) that was present in the ascitic fluid of mice bearing intraperitoneal tumors and in pleural effusions from human cancer patients was found to promote the growth of a murine tumor and to suppress cell-mediated tumor immunity. However, the hosts that had recovered from the immunosuppressive state produced a serum factor that could neutralize the immunosuppressive effect.


Osteogenic sarcoma in a patient with aplastic anemia.

Osteogenic sarcoma developed in a 14-year-old boy 13 years after he had partially recovered from chloramphenicol-induced aplastic anemia. A possible relationship is considered between aplastic anemia, chloramphenicol, testosterone, prednisone, and osteogenic sarcoma. Leukemia has been reported following chloramphenicol-induced aplastic anemia and liver tumors have been associated with testosterone therapy. Certain chemicals have caused osteogenic sarcoma in animals. Thus, we believe there are sufficient a priori reasons to question an etiologic relationship between the cause or treatment of aplastic anemia and osteogenic sarcoma.


[Effect of dental alloys on salivary alkaline and acid phosphatase, alpha amylase K+, Na+, and Cl-].

Comparative studied were performed in healthy subjects without metals in their oral cavities and in individuals having different metal alloys (gold, steel, amalgam) in their mouths and presenting with various complaints such as xerostomia, burning mucosa, etc. It was found that the contents of alkaline and acid phosphatases, alpha-amylase, K+, Na+ and Cl- in saliva increased significantly with the increase in total corrosion potential when non-precious metal alloys, especially different types of alloys, were present. Parallel to this, the frequency and the intensity of the complaints increased.


[1st experiences with the use of the new radio-protective shield in routine dental radiodiagnosis].

The authors report of practical experience with a radioprotective shield. This kind of radiohygiene is recommended for routine stomatological radiodiagnosis by the State Board of Nuclear Safety and Radiological Protection of the GDR.


[Measures for the prevention of incidents in ambulatory dental surgery].

The purpose of the present review is to suggest to the practising stomatologist simple measures against incidents. The importance of history taking and examination, psychoprophylaxis and other preparatory measures in outpatients is emphasized.


[Various hygienic problems in ambulatory dental surgery].

Oral surgical interventions on an outpatient basis are attended by considerable hygienic hazards. The main reasons of this, which are in part subjective and in part objective, are presented. Some typical examples show that at least minimal hygienic requirements may be met by the physician and by the patient also under apparently unfavourable conditions. An optimal solution must be aimed at, but this requires certain prerequisites as to equipment and premises. In any case, it must be called for in planning and establishing greater stomatological services that sould be preferred for this reason to single practices also from the viewpoint of hygiene. Consequently, the propagation of hospitalism and infections caused by pathogenic organisms may be controlled by strict hygienic measures also in our specialty.


[Radiological interpretation of bone regeneration after cystectomy of odontogenic cysts].

38 patients who had undergone surgical intervention (Partsch II) for odontogenic cysts were examined radiographically as well as clinically. The extent of bone regeneration was estimated according to age, sex, location of the cyst in the jaw, cyst size, length of time elapsed after operation and function. To facilitate the interpretation of the results obtained, the patients were subdivided into five age groups. Bone regeneration was most frequent up to the age of 20 (85.7%). It occurred more often in women (in 11 of 16 patients = 68.75%) than in men (in 14 of 22 patients = 63.6%). Bone healing was most favourable in the anterior region of the mandible less, favourable in the posterior region of the maxillae and least favourable in the anterior region of the upper jaw. With increasing size of the cyst, the regenerative power of the bone decreased. An increase in regeneration was observed up to 3 years after surgical intervention.


[Efficiency of amalgam preparation by mechanical mixing using predosed capsules].

With regard to a modified capsule program permitting to predose dental materials in stomatological practice, the clinical use of an amalgamator designed for predosed capsules is evaluated from economic and ergonomic aspects. During two and  a half years of intensive utilization, this amalgamator has proved very successful. Therefore, it may be recommended as an essential element of the capsule system.


[Specific effect of phenytoin application on periodontal diseases].

In the light of clinical evaluations by means of the periodontal disease index and of histologic findings, the present study demonstrates for the first time that the local application of phenytoin may exert a specific and therapeutic effect on parodontopathia mixta.


[Foundations and methods of rational crown preparation].

The targeted removal of dental hard tissues for the purposes of crown stump preparation may be designated as rational if the technique used ist atraumatic and implies the deliberate use of driving systems within different speed ranges and the utilization of adapted abrasive tools in a phase-synchronous and segment-oriented manner. Goal of the preparation is to realize a copy of the clinical crown that is reduced in size, presents less details and has a defined line of preparation.


[Zinc uptake of normal and leukaemic lymphocytes in an in vitro model (author's transl)].

Zinc uptake and/or possible exchange by isolated lymphocytes from normal persons and from patients with chronic lymphatic leukemia and chronic myeloid leukemia were studied in an in vitro model. The uptake of zinc per 10(9) lymphocytes of normal persons was 60 +/- 10 nanomoles and 120 +/- 15 nanomoles during incubation for 30 and 60 minutes, respectively. Two out of the 3 patients with chronic myeloid leukemia showed normal zinc uptake in this test system, whereas zinc uptake by lymphocytes from patients with chronic lymphatic leukemia was significantly decreased (22+/-8 nanomoles in 30 minutes and 35+/-10 nanomoles in 60 minutes).


Diagnostic suction curettage without anesthesia. An investigation into the practical usefulness of the Vabra aspirator.

The purpose of this work is: 1) to answer the question whether the procedure of the Vabra aspiration curettage without anesthesia is well tolerated by the patients; 2) to assess the reliability of the Vabra curettage and to compare it with the conventional curettage in the diagnosis of various endometrial disorder. 262 patients were submitted to the procedure of fractional suctioncurettage without anesthesia; the method succeeded in 261 cases. In 205 cases the histological diagnosis was compared to the diagnosis from a conventional curettage or from a hysterectomy specimen. The method gives histologically reliable results. The tolerance by the patients was good. There were no complications.


The transmural migration and release of blood cells in acute myelogenous leukemia.

The transmural passage of malignant blood cells from the extravascular parenchyma into sinusoidal lumen has been studied in the bone marrow of rats with myelogenous leukemia. The Shay myelogenous leukemia was chosen as a model system because an increased bone marrow cellularity is, in this leukemia, usually accompanied by an increase in circulating myeloid cells. By means of light microscopy, transmission electron microscopy (TEM) and scanning electron microscopy (SEM) it was found that the sinusoidal endothelial lining of the bone marrow remains intact and continuous even in advanced stages of the disease. SEM shows that the malignant myeloblast-like cell enters the sinusoidal lumen by means of a temporary migration pore, which appears only during the transmural passage of the cell. Certain nondegenerative changes in the sinusoidal blood vessels are associated with the myelogenous leukemia. The normal radial alignment of sinusoids about the central sinusoid is changed into a tortuous pattern, and intraluminal cytoplasmic bridges which impede the blood flow are formed by the endothelial cells.


Nonspecific esterase activity in pernicious anemia and chronic erythremic myelosis: a cytochemical and electrophoretic study.

Cytochemically, nonspecific esterase activity was detected in megaloblasts from three patients with severe untreated pernicious anemia, in megaloblastoid erythroblasts from five patients with chronic erythremic myelosis (DiGuglielmo syndrome), and in normoblasts from a patient with severe untreated iron-deficiency anemia. Nonspecific esterase activity in all of these erythroblasts was inhibited by sodium fluoride. Enzymatic activity could not be detected in normoblasts from normal marrows. Electrophoretically, three bands of nonspecific esterase activity could be visualized in marrow sonicates from the anemic patients and normal persons. All of these bands were inhibited by sodium fluoride. The results demonstrate that electrophoretically and in terms of fluoride inhibition, nonspecific esterases obtained primarily from erythroid precursors in various types of anemias are similar to nonspecific esterases found in normal marrows presumably containing a more heterogeneous population of cells.


A population-based study of referral, diagnostic and treatment patterns for childhood acute lymphocytic leukemia.

In order to make decisions about cancer control programs, information is needed on the current management of cancer as actually practiced in the United States. A study to address this issue for acute lymphocytic leukemia in children (age 15 years and under) has been performed. The 101 patients represent all reported incident cases during 1972 in five regions which have population-based registries. Data on patient characteristics, referral patterns, treatment regimens, remission/relapse status, and survival are presented. It is concluded that the treatment strategies developed in leukemia research are reaching the general patient population. The present study can be considered a model for future studies of other forms of malignancy.


Erythroblastic transformation of chronic granulocytic leukemia.

Erythroblastic transformation of chronic granulocytic leukemia was found in seven of 67 unselected patients with blast crisis. This morphologic picture of erythroblastic transformation was indistinguishable from that in erythroleukemia or Di Guglielmo's syndrome. The median survival of the patients with erythroblastic transformation was two months, considerably less than the four-month median survival in the entire series of 67 patients. Only two brief partial remissions were obtained with combination chemotherapy. The causes of death were primarily hemorrhage and infection, related to thrombocytopenia and neutropenia. In this regard, the patients with erythroblastic transformation resembled all the patients with blast crisis and patients with acute leukemia in general. The erythroblastic transformation seems to represent a morphologic variant of chronic granulocytic leukemia blast crisis, without apparent prognostic or therapeutic implications.


Chronic myelocytic leukemia: clonal origin in a stem cell common to the granulocyte, erythrocyte, platelet and monocyte/macrophage.

Glucose-6-phosphate dehydrogenase (G-6-PD) isoenzymes types of granulocytes were determined in eight women with chronic myelocytic leukemia (CML). The patients were heterozygous at the X-linked G-6-PD locus for the common gene, GdB, and a variant, such as GdA, so that both B and A enzyme types were found in skin cells. In contrast to these normal cells, only one G-6-PD type was found in CML granulocytes. The fact that such single-enzyme phenotypes are found in CML granulocytes, but not in nonleukemic granulocytes, provides strong evidence that the disease has a clonal origin. Single-enzyme phenotypes were also found in erythrocytes, platelets and cultured blood macrophages indicating that these cells have a common stem cell which is the site of the abnormality in CML. In the one studied patient, no evidence was found for involvement of cultured marrow fibroblasts. Clonal origin of CML virtually excludes cell recruitment as a sole pathogenetic mechanism. Either the leukemia arises as a consequence of a rare initial event in a single cell, or a series of events occurs in a clone such that it evolves into CML, or both.


Deep overbite correction by intrusion.

Not all patients with deep overbite should be treated with the same mechanics. Some patients require intrusion of the anterior teeth, while others require primarily extrusion. This article has discussed the principles of incisor and canine intrusion and has demonstrated the use of intrusion springs that are capable of intruding incisors with minimal side effects on the posterior teeth. Six principles must be considered in incisor or canine intrusion: (1) the use of optimal magnitudes of force and the delivery of this force constantly with low-load-deflection springs; (2) the use of a single point contact in the anterior region; (3) the careful selection of the point of force application with respect to the center of resistance of the teeth to be intruded; (4) selective intrusion based on anterior tooth geometry; (5) control over the reactive units by formation of a posterior anchorage unit; and (6) inhibition of eruption of the posterior teeth and avoidance of undesirable eruptive mechanics.


Monozygosity in twins: a detailed investigation.

The twins presented in this article showed similarities in their physical make-up to a very high degree. Statistically, however, it is the blood picture which holds the "trump card" in this plethora of evidence supporting monozygous twinning, and it is an essential prerequisite in any presentation of this nature. It is perhaps noteworthy that, while only one of the twins sucked his thumb habitually, there was no difference in the degree of postnormality of the posterior teeth but merely a change in the interincisor relation and in the palatal height. It can clearly be seen from the study of these two twins that the differences between them were very small indeed and could quite easily be classed as individual variations within the same identical genetic pattern. Similarly, in any other identical twins, the way in which one differs from another must be to a similarly small degree or the cause of the difference must clearly be attributable to environmental or acquired influences. Differences which cannot be classed as other than genetic show us that the twins are fraternal or dizygous and, therefore, no more alike than would be two brothers of differing ages.


Retrospective study of intellectual development in children treated for acute lymphoblastic leukaemia.

Nine younger children (mean age 6-3 years) and 6 older children (mean age 9-0 years), previously treated for acute lymphoblastic leukaemia by cranial irradiation and subsequently by 2 or 3 years of chemotherapy, were assessed in terms of intellectual development in relation to 15 controls, matched individually for age, sex, and social background. All children were functioning within a normal range. The older group of children performed as well as their matched controls in all tasks. However, the younger group tended to perform somewhat below their matched controls, and this applied especially to tasks measuring quantitative, memory, and motor skills, but not to language tasks. It is concluded that there is a continual need to monitor the development of children treated for leukaemia, especially when diagnosed in the 2- to 5- year age range.


Prognostic significance of radiological bone involvement in childhood acute lymphoblastic leukaemia.

In 98 children with acute lymphoblastic leukaemia, aged 1 to 12 years, the prognostic significance of radiological bone involvement was studied. The mean duration of remission and of survival was much shorter in cases with multiple bone involvement (3 or more bones) than in those where bone involvement was absent. In those cases presenting with 1 or 2 bone lesions no statement of prognostic significance can be made at this stage. A radiological skeletal survey should be made in all children presenting with leukaemia to identify those (about 15%) having multiple bone lesions and therefore a poor prognosis, in order that they can be given more intensive therapy.


Peritonsillar abscess. A comparison of treatment by immediate tonsillectomy and interval tonsillectomy.

The generally accepted therapeutic regimen for peritonsillar abscess consists of the administration of parenteral antibiotics with incision and drainage followed by interval tonsillectomy in four to six weeks. Treatment by immediate tonsillectomy, however, is practiced widely in Europe and has received recent attention in  the American literature. This report compares the clinical course of patients treated by interval tonsillectomy and immediate tonsillectomy. Patient morbidity was lessened by immediate tonsillectomy, since two separate surgical procedures were avoided, and the total period of hospitalization was reduced by nearly 50%. Advantages and disadvantages of both methods of therapy are discussed.


Osteogenic sarcoma of the maxilla.

Six cases of osteosarcoma of the maxilla are reported, including one case that was radiation-associated and one case that arose in Paget's disease. The literature on this entity is reviewed and the clinicopathologic features of this lesion in this unusual location are discussed.


Oesophageal atresia: triumph and tragedy.

An enormous amount has been written about oesophageal atresia during the last 30 years. This is not surprising because it is not so long ago that the condition was uniformly fatal, and even today, a generation after the first successful operations, many problems associated with its management have not been completely solved. This lecture discusses past and present management, past and present results and future prospects of infants suffering from this malformation.


The effects of seat belt legislation on road traffic injuries.

The compulsory wearing of seat belts, first introduced in the world in Victoria in 1970, has effectively reduced the number of deaths and injuries by approximately one-third for car occupants involved in motor vehicle crashes. Initially, the legislation did not apply to children under the age of eight years, but in 1975 a further law was introduced banning children from the front seat of any vehicle unless properly harnessed. Seat belts offer the best protection for front seat drivers and passengers involved in frontal impacts, but offer less protection to the recipient of a side impact. Ten per cent of car occupants admitted to hospital after a frontal impact show injuries, mostly minor, directly attibutable to the wearing of seat belts.


Alcohol, road crash casualties, and countermeasures.

Alcohol is a major contributing factor in over one-third of all road fatalities in this community. Almost half the fatalities occur in people aged less than 25 years of age. Results of recent compulsory blood test legislation in Australia and New Zealand are presented and provide incontrovertible evidence of the vast extent of the problem of alcohol on the road. The social and drinking profiles of road crash casualties with blood alcohol concentrations greater than .05 g/100 ml differ from those of other casualties. Countermeasures used in the control of this epidemic include legislation, improved community education, and greater awareness of the need to rehabilitate rather than to penalize.


Aspects of injury patterns in automobile accidents.

During the period June 1971 to June 1973, the injuries of 34,378 persons involved in accidents attended by ambulance officers, and treated by hospitals, together with the injuries received by 1,699 victims investigated by coroners, were analysed. Clear-out injury patterns emerged for different types of road users. Pedestrians in general suffered injuries of greater severity than cyclists, who in turn had injuries of greater severity than vehicle occupants. The extent to which car occupant injury patterns are modified by seat belts is demonstrated. Injuries suffered by the wearers of seat belts occur less frequently, and are less severe, less likely to prove fatal, and less likely to cause long stays in hospitals.


Traumatic rupture of the thoracic aorta.

Eleven patients with aortic rupture secondary to non-penetrating thoracic trauma, recent in four patients and of longer standing in seven, have been operated upon. Every patient with an acute injury had a widened mediastinum in the chest skiagram. The diagnosis of traumatic rupture was made by aortography in each case. The operative procedure involved cardiopulmonary bypass, left heart bypass or aorta to aorta bypass shunt. There was one postoperative death. It is recommended that in the acute stage a rupture of the aorta secondary to trauma should be repaired as soon as possible, while ruptures of long standing should be electively repaired.


The non-operative management of splenic trauma.

Non-operative management of splenic trauma is not a widely accepted method of treatment. During the period 1964 to 1976, 39 children were treated in the Adelaide Children's Hospital for splenic trauma. Twenty-four were managed without operation, while 15 were treated by splenectomy. Recently, splenic scan has helped in the diagnosis and management of splenic injuries. From our observations, it appears that non-operative treatment of a proven splenic injury is safe and the ideal initial treatment in the paediatric age group, when the spleen is the only intraabdominal organ injured, and the vital signs are stable with the application of adequate resuscitative measures.


Severe chainsaw injuries.

A survey of 47 patients who sustained severe chainsaw injuries has been carried out. It shows that this machine, while an extremely useful one, is hazardous. Most of the patients were young, and over half of the injuries involved a hand. One fatality was recorded.


Osteomalacia in the elderly.

Over recent years it has been demonstrated that there is a significant incidence of osteomalacia in elderly patients presenting with fractures of the femoral neck. The results of a survey carried out on all patients admitted to St Vincent's Hospital, Melbourne, with fractures of the upper end of the femur over a 12-month period are presented, and the condition of osteomalacia in the elderly is discussed. It is concluded that in this community osteomalacia does not present as a practical problem except in those patients who have the condition as a result of a definite predisposing factor.


A scanning electron microscopic study of wear in the plastic components of prosthetic knee and hip joints.

The polyethylene surfaces of four metal on plastic prosthetic knee joints were compared with those of four hip joint replacements, by the use of scanning electron microscopy. The acetabular components of the hip joints showed concentric machining marks, but were generally smooth, and in some areas plastic deformation of the articular surface was evident after 24 months' use. In contrast, the tibial components of knee joints removed after 12 to 22 months showed deep scoring and pitting near the centre of their articular surfaces. This appeared to be due to abrasion by a third material, possibly fragments of cement, which sometimes became embedded in the joint surface. These results indicate that wear in prosthetic knee joints may be much more rapid than in hip joint replacements made from similar materials.


Craniofacial surgery: the team approach.

Craniofacial surgery offers a new hope to some grossly deformed people. This complex surgery, which is based on a multidisciplinary team approach, needs to be carefully rationalized and regionalized to facilitate investigation, to improve planning, to reduce the number of complications, and to conserve financial resources. To date the Cranio-Facial Clinic at the Adelaide Children's Hospital and the Royal Adelaide Hospital has reviewed 37 cases and operated upon 13 of these. This work is presented together with a review of the team approach.


Ultrasonic echography in the diagnosis of abdominal disease.

The place of two-dimensional ultrasonic echography in the diagnosis of surgical diseases of the abdomen is outlined, and illustrative cases are described. The method is safe and can be repeated as often as required. It does not replace radiological or radionuclide examinations, but complements those techniques.


Acute pancreatitis: the Queensland scene.

One hundred patients suffering from acute pancreatitis and studied in two large teaching hospitals in Brisbane between 1959 and 1973 were reviewed. Gallstones were present in 43 patients (of whom 31 were female), and a history of alcoholic excess were elicited in 23. Sixty-three patients were aged over 50 years. Characteristic clinical features included spreading epigastric pain with radiation to either of the upper quadrants of the abdomen. Left-sided upper abdominal peritonitis associated with severe repetitive vomiting was suggestive of the diagnosis. The serum level in most cases fell below the arbitrary diagnostic level of 500 Somogyi units/100 ml within 72 hours of the onset of the pain. Acute haemorrhagic necrosis of the pancreas was positively diagnosed in 15 patients, six of whom died. The overall mortality rate in the series was 9%.


Benign non-parasitic cysts of the liver: a review of 18 cases.

Benign non-parasitic cysts of the liver are a clinical and pathological curiosity except when they cause symptoms or are incorrectly diagnosed as metastases in patients with abdominal malignancy. It is difficult to make a correct diagnosis of benign liver cysts in spite of the armamentarium of modern diagnostic aids available, and on many occasions the diagnosis is made at laparotomy. This is a report of 18 patients with benign cysts of the liver, two of whom suffered complications which we believe have not previously been reported.


Xanthogranulomatous pyelonephritis in Malaysians.

Eight cases of xanthogranulomatous pyelonephritis occurring in an oriental population are reported. The patients were mostly middle-aged, and there was a female preponderence. Nephrectomy controlled the disease in all cases. Diagnosis on clinical and radiological grounds is difficult, and it is often only made on pathological examination of the kidney after nephrectomy. The nature of the disease remains obscure.


Left hepatic lobectomy and resection of a carcinoma involving the confluence of the right, left, and common hepatic ducts.

This is a report of a single case of carcinoma involving the confluence of the right, left, and common hepatic ducts, treated by left hepatic lobectomy and resection of the tumour. The clinical onset of symptoms with pruritus and steadily deepening jaundice was typical of the condition, as was the difficulty in establishing a diagnosis. Radical treatment for this tumour, which is frequently slow to metastasize, is advocated. The importance of complete filling of the billiary tree during operative choledochography is highlighted.


Idiopathic chondrolysis of the hip: case report with a review of the literature.

The first case of idiopathic chondrolysis of the hip from South-East Asia is reported, with a review of the literature. The problems of differential diagnosis are discussed. As the condition is rare, it is likely to be misdiagnosed and may well be over-treated. The rarity of the condition and its natural history terminating in spontaneous fusion make it mandatory that a correct preoperative diagnosis be established in order to avoid needless radical surgery. Some of the significant clinicopathological findings are highlighted.


Surgical repair of a large incomplete cleft sternum.

Congenital deformities of the chest are not uncommon, are frequently symptomatic, and are readily correctable. This applies particularly to malfusion of the manubrium and upper sternum, which results in a bony deficiency together with divarication of the sternomastoid muscles and the sternoclavicular joints. Such defects of the sternum are best corrected as soon after birth as possible. Two patients are reported who had such a defect, and the technique for a satisfactory repair is described.


Ureteroureterostomy for ureteric duplication with one pathological renal segment.

An operation for the management of ureteric duplication with one pathological renal segment is described. A report of 13 cases with 15 duplex systems is presented, showing the merits of ureteroureterostomy as measured against the established procedures.


On the form and function of the abductor pollicis brevis muscle.

The abductor pollicis brevis muscle acts in conjunction with the palmaris longus and the abductor pollicis longus to abduct the first metacarpal in the sagittal plane. Segments of the abductor pollicis brevis which arise from the tendons of the palmaris longus and/or the abductor pollicis longus and are inserted into the extensor expansion are the lumbricals of the thumb. The lateral border of the abductor pollicis brevis presents an important muscular (in four cases out of ten neurovascular) hilum. The tendinous slip to the abductor pollicis brevis from the palmaris longus presents near its origin an orifice which the palmar branch of the median nerve traverses to become superficial.


Injury control: a state-of-the-art review.

There is a growing body of new knowledge suggesting that trauma should no longer be conceptualized as a behavioural phenomenon with the associated connotations of chance, unexpectedness and blame worthiness. Instead, it should be regarded as a public health problem amenable to scientific, research-based strategies of the type that have been successfully introduced in the fight to conquer infectious disease. If progress is to be made in reducing the toll of accidental mortality and morbidity, the current need is for the increased allocation of resources to develop, extend and disseminate this new knowledge.


[Detection of an antigen, associated with cells during the blast crisis of chronic myeloleukemia, in a cytotoxic test using xenogenic antibodies].

The immune antimyeloblast serum (AMS) was obtained from horses immunized with white blood cells from patients suffering from chronic myeloid leukemia (CML) at the blast crisis stage; the serum was completely absorbed with normal red blood cells and white blood cells (WBC). The absorbed antiserum remained cytotoxic to blast cells from 20 of 42 patients with CML at the blast crisis stage. AMS failed to react with the WBC from patients with CML in its chronic phase, and from patients with other types of leukemia Morphological studies indicated a possibility of identification of the antigen associated with myeloblasts from the blood of patients with CML blast crisis, by means to AMS.


Multiple-drug chemotherapy for acute leukemia The TRAMPCOL regimen: results in 86 patients.

A combination of eight cytotoxic drugs, administered simultaneously, has been used in 86 cases of acute leukemia. The regimen, designated TRAMPCOL, incorporated thioguanine, rubidomycin, (daunorubicin), cytosine arabinoside, methotrexate, prednisolone, cyclophosphamide, vincristine, and usually L-asparaginase. Treatment was administered in five-day pulses with treatment-free intervals varying from nine to 23 days. Subjective and objective toxic effects were not more severe than those seen with two- and four-drug regimens previously employed. Substantial clinical and hematologic improvement occurred in 8/19 patients with chronic granulocytic leukemia (CGL) in acute transformation. Complete clinical and hematologic remission (CR) was achieved in 3/7 patients with untreated acute myeloid leukemia (AML), 5/19 patients with AML who had failed to achieve CR with other therapy, and 4/18 patients with AML in relapse after CR obtained with regimens other than TRAMPCOL. CR occurred in 15/17 patients with acute lymphocytic leukemia (ALL), most of whom had had multiple previous relapses. CR was not achieved in four patients with AML superimposed on pre-existing myeloproliferative disorders. The TRAMPCOL regimen merits further evaluation in CGL after acute transformation, as a primary treatment for AML, and as therapy for ALL 1) in relapse, 2) in adults, 3) in children with adverse prognostic features, and 4) in T-cell ALL.


Five-year survivors among children with acute leukemia in Japan.

This Japanese nation-wide survey was carried out on long-term survivors among children with leukemia, i.e. those who had survived more than 5 years by October of 1974. Eighty-three children were surveyed. This was about 2.5 times as many as the 31 children surveyed in the first Japanese nation-wide survey in 1971. Clinical and laboratory data were also analyzed statistically and compared to that of the first survey. Most of the children had received inductive therapy according to the old protocol, but 10 children were treated with a combination of VCR and steroids. Nine of these 10 were still in a state of remission. CNS involvement occurred in 15.3% of the cases and a late onset of this complication implied a prognostic significance: among the 9 children whose complication had occurred 3.5 years after onset of the disease, 6 died. The relapse rate decreased between the 4th and 5th year after initiation of maintenance therapy. The percentage of the risk of death became zero after the 9th year.


Complete remodeling of the vertebrae in a child successfully treated for acute lymphocytic leukemia (ALL).

This report describes a 10-year-old white boy who presented with acute lymphocytic leukemia (ALL) and several collapsed thoracolumbar vertebrae in 1965. His ALL was successfully treated, and he has been disease-free for over 10 years. He has now completely remodeled all of the collapsed vertebrae.


Rationale for combined therapy.

The presence of micrometastatic disease at the time of diagnosis is the major cause of failure in the treatment of cancer. The mechanisms, biology, and biochemistry of tumor metastases at an experimental level are being effectively studied. Potential control points and therapeutic implications are emerging. These are being employed in the construction of clinical trials involving adjuvant chemotherapy. This is part of combined modality treatment in which the best of treatment design to achieve local control (surgery and/or x-ray) is combined with systemic treatment (chemotherapy and/or immunotherapy) designed to irradicate microscopic metastases. The evolution of such studies in patients with breast cancer and osteogenic sarcoma over the past five years is presented. Disease-free survival has improved as a result of adjuvant chemotherapy for both of these diseases. While a longer follow-up will be required to determine more precisely the impact of multi-disciplinary treatment on these and other diseases, the short-time results are promising.


Antimetaboliths in the prophylaxis and treatment of central nervous system leukemia.

The results of the administration of two antimetabolites, methotrexate (MTX) and cytosine arabinoside (Ara-C), for the prevention and treatment of established central nervous system (CNS) disease in children with acute lymphoblastic leukemia are discussed. Two protocols (L-2 and L-10) for the management of patients with acute lymphoblastic leukemia have been developed. In the L-2 protocol, prophylaxis consists of repeated intralumbar injections of MTX alone, and in the L-10 regimen, both MTX and Ara-C are administered; for the patients with an initial leukocyte count of greater than or equal to 25,000/mm3, the two drugs are given intraventricularly instead of by the usual intralumbar route. In the treatment of established CNS leukemia, intralumbar MTX and Ara-C in addition to CNS irradiation are employed; for maintenance, periodic intraventricular MTX injections are given. Of the 70 children receiving the L-2 protocol, four developed CNS leukemia and in a fifth patient, CNS and bone marrow relapse were concurrent. Among the 31 children receiving the L-10 regimen, CNS disease has been observed in only one child. Of the five children treated for the established CNS leukemia, recurrence was observed in two at 19 and 29 months after remission; the other three remain in remission for 2, 15, and 39 months, respectively.


High-dose methotrexate in acute lymphocytic leukemia.

A pharmacokinetic study of methotrexate (MTX) was performed in 60 patients who received high-dose MTX at 500 mg/m2 infused over 24 hours. MTX levels reached 1.2 X 10(-7) M in the cerebrospinal fluid (CSF) within 10 minutes and remained constant at that level for 24 hours. Forty of these 60 patients were children with acute lymphocytic leukemia. In these 40 patients, simultaneous intrathecal MTX was given along with high-dose MTX. The resultant CSF levels (lumbar area) were higher than those obtained with either high-dose MTX alone or simultaneous intrathecal MTX alone. To date, there have been one systemic and one central nervous system relapse in these 40 children, and the treatment program appears safe to administer.


Cyclic alteration of electrophoretic property associated with growth circle in HeLa S3 cells.

Changes of electrical cell-surface charge associated with cell cycle were examined electrophoretically in the synchronous culture of HeLa S3 cells. The electrophoretic mobility of the cells increased abruptly in the mitotic phase as high as 45% compared with that of cells in the S phase. This difference of mobility was obtained by comparing pure population of mitotic cells and S-phase cells. Mitotic cells were also found to be more susceptible to neuraminidase than S-phase cells in term of electrophoretic mobility, a greater amount of sialic acid being correspondingly released from the former. The mechanism of the electrokinetic change associated with the processes of cell cycle is discussed, with special reference to the distribution of electric charge in the cell surface membrane.


Postoperative scars and cleavage lines.

We elucidated the pattern of skin cleavage lines of the neck of Japanese cadavers and studied the scarring in 42 cases of radical neck dissection for the removal of metastatic nodules from the malignant tumors of the oral region, in the operation of which one incision was made parallel to, and another perpendicular to, the cleavage lines. From this study we came to the following conclusions: 1) The cleavage lines run parallel in ring-form around the neck, with the exception of the back and the lowermost part of the base of the neck. Seen from the side, the lines run horizontally across the neck.  2) Raised and widened scars were few at the site of the incision parallel to the cleavage lines but there were seen often at the site of the perpendicular incision. 3) There were no raised postoperative scars in the patients who had received radiotherapy prior to the time of observation.


A comparison of plaque removal by different toothbrushes and toothbrushing methods.

Six toothbrushing methods were evaluated using several kinds of toothbrushes. Two kinds of electric toothbrushes were tested also. Forty-two adults who had normal dentition and clinically healthy peridontal tissue, aged 20 to 34, 36 males and 6 females, volunteered for this study. The plaque score was calculated by the modified Volpe's method on which Suzuki et al. reported before. The scoring of the plaque was restricted to the six teeth (formula: see text) The average percentage of plaque removal from the total (labial and lingual) tooth surface by different toothbrushing methods was as follows: (1) 75.2 +/- 9.9% by the Fones method with a hard brush, (2) 71.7 +/- 11.1% by the Scrub method with a hard brush, (3) 67.4 +/- 12.5% by the modified Stillman's method with a hard brush, (4) 64.7 +/- 13.7% by the National electric toothbrush with a soft brush, (5) 62.9 +/- 13.6% by the Roll method with a hard brush (6) 58.1 +/- 16.3% by the Charters method with a brush of a medium hardness, (7) 55.2 +/- 10.2% by the Bass method with a brush of a medium harness. A similar tendency was obtained independently on the labial, lingual and papillary tooth surface. The hard brush was the most effective for the plaque removal by all kinds of brushing methods.


Anthropometry of the face in lateral facial dysplasia: the unilateral form.

The skull, face and ears of 46 patients with the unilateral form of lateral facial dysplasia were examined at the Hospital for Sick Children, Toronto, using anthropometric methods for the purpose of contributing to the morphology of this syndrome. The classical picture of unilateral facial asymmetry with microtia was found in 13 cases (28.3%). The study showed bilaterally defective mandibular arc measurements in 28 per cent of the cases. The facial damage was associated in 15 per cent with ears normal in size but defective in location, level, and shape. The anthropometric examination revealed a great variety of defects on both sides of the face, often barely detectable by routine inspection. It was also found that great deficiencies in the surface measurements were accompanied by great bone deficiencies.


Performance of normal six- and seven-year-old males on oral manometer tasks.

An assessment was made of oral manometric performance of normal speaking six- and seven-year-old boys. Readings of maximum, sustained, positive and negative pressure with bleed and nostrils occluded and open were obtained from each of forty subjects. It was found that the majority of normal speaking six- and seven-year-old boys had considerable difficulty generating and maintaining stable, maximal positive and negative pressure upon repeated trials of each of four manometric tasks. The findings of this project support the general hypothesis that oral manometric ratio data may be of questionable diagnostic value in predicting velopharyngeal adequacy for speech, particularly if ratio data must be interpreted dichotomously. The observations made were interpreted to support the view that there may be substantial differences even within the normal population in the ability to perform manometric tasks. The present results suggest that operational procedures commonly used during manometric testing merit rigorous scrutiny, re-examination and analysis.


The role of the mandible in mouse palatal development revisited.

Growth changes associated with formation of the secondary palate were studied in H-Velaz mouse embryos by morphometric measurement of medial sagittal sections of the heads between days 13 and 15 of embryonic development. Horizontalization of the palatine processes depends primarily on the length of the mandible and is effected by a shift of palatine process material into the supralingual space. The administration of 7.5 mg cortisone acetate im to the female on day 12, of 0.5 mg 6-aminonicotinamide im on day 14, or amniocentesis on day 14 significantly retards growth of the embryo in general and of the mandible in particular without significantly affecting deflexion of the skull base. The different spatial conditions created by disproportion between deflexion of the base and the length of the mandible cause irregularities in the course of horizontalization which lead, as a rule, to cleft palate.


Dermatoglyphic analysis of primary and secondary cleft palate patients.

No significant differences are found among the different groups. Some of the observed minor differences between the cleft and the control groups may be the result of sampling error. Our findings are not surprising because our cleft patients have no other congenital anomalies. Indeed aberrant dermatoglyphic patterns are found mainly in generalized dysmorphogenesis, such as in chromosomal syndromes, rather than in isolated congenital malformations, exception being made of course for congenital malformations of the hand itself.


Prevalence of cleft uvula among 2,732 Danes.

A total of 2,732 patients at the Royal Dental College, Copenhagen, were studied for occurrence of cleft uvula. The prevalence was 1.13%, and the ratio of partial to total clefts was 30:1. From a comparison with results of previous studies, it is concluded that the prevalence of cleft uvula in the Danish population appears to be in the same range as in other white populations which have been studied.


Cleft palate in two syndromes.

Patients with cleft palates with or without cleft lip need more special attention at birth when the cleft is associated with other malformations. For example, the Pierre-Robin and the Klippel-Feil Syndromes are both well known for the special problems they present. Reported here are three cases, with Crouzon's and two with Franceschetti Syndromes, all of whom have palatal clefts.


Cleft palate and multiple anomalies in one of two siblings with partial 13 trisomy.

Siblings with multiple congenital anomalies secondary to familial partial trisomy of chromosome number 13 are described. In addition to other findings, the younger child exhibited a cleft of the soft palate. The mechanism of transmission of the chromosomal abnormalities, the relationship of the physical abnormalities and the chromosome findings, and the significance of these findings in the consideration of recurrence risks in future pregnancies are discussed.


Properties of the alpha-glucosidase from various human tissues in relation to glycogenosis type II (Pompe's disease).

The physico-chemical and electrophoretical properties of alpha-glucosidases from various human tissues and urine have been studied. There were some differences among Peak I enzymes (neutral alpha-glucosidases) obtained from liver, heart, muscle, kidney and urine. These differences are based on different effects of tris(hydroxymethyl)aminomethane and various thermostabilities of the Peak I enzymes. Electrophoretically, the Peak I enzyme activity at pH 6.5 from control tissues displayed a two-banded pattern except in kidney and urine. In the patient with the adult form of Pompe's disease the faster band of the Peak I enzyme from heart and muscle was not found and the slower band of the Peak I enzyme from liver was more cathodic. The results are discussed in relation to glycogenosis type II (Pompe's disease).


Radical resection for osteogenic sarcoma of fibula with preservation of the limb.

This is a report of a 15 year old girl with osteogenic sarcoma of the proximal fibula treated by en bloc radical excision without amputation of the limb. The anatomical individuality of the fibula, vascularization of the leg and effective adjuvant chemotherapy determined the feasibility of the procedure. There is no evidence of tumor recurrence 27 months after surgery.


Adult-onset acid maltase deficiency. Case report of an adult with severe respiratory difficulty.

Pompe's disease (acid maltase deficiency) classically affects infants and children, with a few sporadic cases occurring in adults. An adult patient initially have progressive muscular weakness, exertional dyspnea, diaphragmatic paralysis, and objective evidence of restrictive respiratory disease. Muscle biopsy established the diagnosis of acid maltase deficiency. The patient's brother had died at the age of 44 years, after 23 years of a "progressive muscular dystrophy." Acid maltase deficiency should be considered in the differential diagnosis of progressive respiratory insufficiency associated with weakness.


[The effect of toothpaste on the gingiva].

Under standarized conditions, foils are applied and removed from the attached gingiva of the mandibular anterior region. The amount of epithelial cells clinging to the test foils was determined. When compared to toothpastes with the usual content of surface active substances, the short contact of a toothpaste containing a high percentage of wetting agents increases the number of epithelial cells loosened by mechanic forces.


[Endosseous endodontic implantation in front teeth with horizontal fractures in the median third].

The recommendation to use pin implants as fixing elements in horizontally fractured roots of anterior teeth is based on our own animal experiments as well as on clinical and radiological examinations of six patients. The examinations were made in 14 anterior teeth fixed to the bone by a pin the roots of which had been reduced to about half the physiologic length by resorption, amputation or fracture. The original biomechanical situation was the same in all three types of root reduction. We observed the pin-fixed teeth for 2 1/2 years on the average.


[Therapy of chronic apical periodontitis in traumatically injuring front teeth with ongoing root growth].

Because of the patient's age and the width of the apical foramen, conventional or surgical root canal fillings are frequently not indicated for the treatment of chronic apical periodontitis in teeth whose roots have not yet fully grown. Therefore resorbable paste fillings are applied either to induce deposition of apical hard substance or to bridge the time until root canal filling is possible. In a comparative clinical and radiological study in 171 young patients, Walkhoff's iodoform paste and calcium hydroxide were examined with regard to their inductive effect on the formation of an apical hard substance barrier.


[Simulation studies on depot iontophoresis].

The rapidity with which OH-ions as well as long-acting Cu-compounds are transported from a depot of copper calcium hydroxide through all canals of the apical delta to all openings of the delta even when mechanically inaccessible is demonstrated by means of model experiments in extracted teeth.


[New developments in depot inotophoresis of copper compounds].

By means of two methods of the depot ionophoresis using an exterior voltage source and the galvanic pin element, polyvalent bactericidal compounds can be transported from a depot of copper calcium hydroxide into all arms of the apical delta. The method of working and long-term effects are described.


[Length measurement of the root canal].

Twenty-five years of experience in the field of length measurements of the root canal are summarized. It must be concluded that there is no absolutely accurate method to measure the length of the root canal in vivo because of the specific anatomic conditions and the sources or error inherent in all methods. Of the various methods, preference should be given to the so-called graduated instruments. They do not require additional work and enable the observation of aseptic precautions. The industry must be requested to make these instruments available again.


[Natural fluorides. The distinction between technically produced and naturally occurring fluorides in caries prophylaxis].

In the controversial discussion of the bio-availability of fluoride in caries prophylaxis by fluoridation, fluorides coming from the geochemical circulation to the biochemical circulation are sometimes differentiated from synthetic fluorides introduced into fluoride medication. The question as to whether such a differentiation is essential can be answered from the physical-chemical point of view. This requires a wide field of scientific research starting with geochemistry and the knowledge of fluoride deposits, sedimentology, hydrology, technology of inorganic and organic fluorine compounds, thermodynamics of dissolved fluorides, up to biocrystallography and biochemistry of fluorine.


[Bioavailability of fluorides from various salts and from various dietary components].

In six male subjects fluoride bio-availability after oral application of NaF and MgF2 was examined and the influence of food on fluoride absorption was studied by recording fluoride level in plasma and parotid saliva for 24 hours. In addition, fluoride profiles in the plasma of four beagle dogs after the intake of fluoride as NaF, MgF2 and CaF2 with and without addition of milk and dairy products were established. There were great differences in extent and speed of absorption among the different preparations some of which were demonstrated not to release fluoride at all. As was expected, absorption was quicker and more complete in patients with empty stomach than with simultaneous food intake. Milk and dairy products delay fluoride uptake without considerably reducing the overally amount of fluoride resorption.


[Oral leukoplakias. I. Classification, differential diagnosis, etiological conditions for neoplastic transformation, prognosis].

Leucoplakia is due to abnormal keratinization of squamous epithelial mucosa and constitutes a pattern of reaction of the oral mucosa which is typical for the tissue but unspecific for any stimulus. Because of its numerous causes leucoplakia cannot be defined as a pathologic entity. There is leucoplakia in the narrow sense and leucoplakia in the broad sense; the first should be regarded as a polyetiologic symptom but not as a disease in itself. Leucoplakias in the broad sense comprise those caused by well defined disorders. A classification of oral leucoplakias must include both categories, for differential diagnostic reasons. Therefore a classification of leucoplakias in the broad sense (hereditary 1., endogenous-irritative 1.) and leucoplakias in the narrow sense (exogenous-irritative 1., precancerous 1.) is proposed. The latter category is largely identical with the WHO definition of leucoplakia. The most important clinical and histological grounds on which this classification is based are explained. The precancerous lesions and the present knowledge of stomatology and oral pathology are particularly taken into consideration.


[Branchiogenic preauricular fistulae].

Seventeen patients with dimples, fistulae and cysts in the region of the cheek and the preauricular field are reported. All are located in the neighborhood of the dorsal end of the first visceral arch. Both the fistulae of the ascending helix and the upper preauricular fistulae must be regarded as relics of the dorsal end of the first branchial cleft. This interpretation supports the theory of Wood-Jones and I-Chuan according to which the tragus is formed from the material of the mandibular arch, and the remaining part of the auricle from the mesoderm of the second visceral arch. Similar anomalies in the neighborhood of the angle of the mouth, the extraoral opening of an accessory duct of Stensen and the inferior preauricular fistula are sufficiently explained by the incomplete closure or tearing of the embryonal oral aperture.


[Experience with titanium mesh as a temporary foreign material implant for the reconstruction of mandibular defects].

Restoration of a loadable mandible after extensive resections, defects or comminuted fractures, serious osteomyelitis and pseudarthrosis will be successful only if sufficiently stable fixation of the fragments and immobilization beyond the physiological period of bone healing are guaranteed. By means of various types of plates and extroral appliances for osteosynthesis the conventional methods have been improved, but failures and complications are still frequent. The treatment itself is a great strain for the patient. The titanium mesh implant system developed by Ph. Boyne and  his group for reconstruction in mandibular defects means, in our opinion, an important therapeutical step forward. Its technical advantages and our own clinical experience advocate application of this system.


[The image of the temporomandibular joint in the panoramic radiographs].

Of the general panoramic radiographs those with an intraoral focus (magnifying panoramic radiography) are not suitable to represent the temporo-mandibular joint. In contrast, panoramic tomograms represent the temporo-mandibular joint better, but they cannot be recommended unreservedly for the exact evaluation of this region. Presently there is no substitute for conventional radiographs.


[Epidemiology of hypodontia in the permanent dentition].

The incidence of hypodontia of the permanent dentition was studied in a total of 3986 students, 11 to 21 years old, in secondary schools in Fürth in Bavaria. In 5.1% of all subjects hypodontia was observed. Most frequently involved were the lower second premalars (37.8%), the upper lateral incisors (29.0%), and the upper second premolars (22.4%).


[Microsymptoms as an indication for familial hypodontia, hyperdontia and tooth displacement].

Hitherto several micromanifestations could be recognized as signals of pathognomic etiological factors indicative of aplasia, or, better, as disposition to disorders of the odontogenetic organs. Such microsymptoms are reduction of size, especially observed in upper lateral incisors (peg-shaped teeth), delayed mineralization, and dystopia of tooth-germs. Our findings suggest that many further phenomena belong to the same group of micromanifestations such as supernumerary teeth, either of typical or atypical shape (mesiodentes), supernumerary cusps and roots, gemination and fusion of teeth, infraposition of deciduous molars with a tendency to inclusion, just as undermining resorption of the (upper) second deciduous molar caused by the first molar, and, last but not least, a large distance of the germ of the (lower) second molar from the first molar as well as retention of those teeth. Such micromanifestations are theoretically important as clues on the trail of hereditary and practically useful as indicators of hyper- and hypodontia and dystopias in the same patient or among his close relatives.


Studies of malformation syndromes of man XLVII: disappearance of spermatogonia in the Fanconi anemia syndrome.

A 15 year old boy with the Fanconi malformation-aplastic anemia syndrome developed erythroleukemia and died of multiple arterial thromboses and hemorrhage. He was one of 10 siblings including 3 affected sisters. He was short of stature and had hypoplastic thumbs; his testes were small and secondary sexual characteristics were inadequately developed. At autopsy he was found to have very few spermatogonia, i.e., a histological picture compatible with the "Sertoli-cell-only" defect. Male hypogonadism in other chromosome breakage syndromes (the Bloom syndrome and ataxia telangiectasia) may have a similar pathogenesis.


Dentist-staff interpersonal relationships.

The growing demand for dental services has resulted in an expanded utilization of auxiliary personnel in an effort to increase productivity. Enlarged dental teams which have evolved from this effort have also magnified the potential for interpersonal conflicts in the office. Although such conflicts are sometimes unavoidable, they can be reduced through effective preventive management. Careful selection of personnel, well designed training programs, and attention to those factors which assist retention of qualified staff members are important in this process. Finally, the entire team must have common goals and work in a coordinated fashion to achieve ultimate success. The dentist of today must possess the skills of an effective manager as well as those of a competent clinician.


Sharing leadership influence: a life-cycle model.

We have described the effective leader in terms of several concepts: (1) leadership style as a means of sharing the influence of leadership with a ready group; (2) the readiness of a group to successfully exert influence on the practice; (3) the matching of leadership styles with group readiness; and (4) the impact of the environment on the readiness of a group. We have described how all of these elements combine to determine a leader's effectiveness. All elements interact and present the leader with a situation for which he must adopt an appropriate leadership style (Table 1). Several elements combine to change the readiness of a group through four phases - unready, ready, mature, and professional. The leader then matches leadership styles I through IV to these levels of readiness. We believe a dentist will be effective as a leader in proportion to his success in matching an appropriate leadership style to the readiness of his group to perform in its particular environment.


Management by objectives for the dental office.

Management by objectives is a better way to run a dental practice. The required planning will take additional time in the initial stages but can save a great deal of time in the long run. The major requirement is the establishment of specific measurable objectives over a defined period of time. Encouraging your staff to participate whenever possible will result in better objectives, more commitment, and greater motivation. By stating where you want to go and developing plans to reach this destination, you will be able to work smarter and not harder.


Effect of patient behavior and personality on treatment planning.

Several models are described that show the interrelationship between the patient and his behavior/personality, the dentist, and the proposed plan of treatment for each patient. The patient assessment model is introduced, which asks neither the patient nor dentist to change, but through identification of personality characteristics of the patient, modifies the plan of treatment to fit the individual's need. To accomplish the aspect of personality assessment, the locus of control is employed. This instrument distinguishes between two distinct types of individuals, "internal" and "external." Through this classification of patients, the dentist can more clearly define the necessary treatment plan that fits the needs and wants of dissimilar patients.


Effective utilization of forms for efficient office communication.

The efficient use of forms can increase the effectiveness of communication with the office, staff, and with the patient. An effective form meets a specific need, does so in the simplest possible way, and is flexible in its use. The use of the modified buck slip with the pegboard system directs the treatment schedule for the receptionist, gives the patient more detailed financial information, and postpones the ledger card and journal entry until a more convenient time. It also permits you to communicate with the office staff in a clear manner. At the very least it eliminates second guessing. The use of the modified truth-in-lending form increases the effectiveness of the communication with the patient as to the procedures to be performed and reinforces the diagnosis and the payment arrangements. The use of a patient treatment follow-up slip provides a simple system for communication between the postoperative patient and doctor. Such forms increase the efficiency of the total practice.


Psychological, physiological, and pharmacological management of pain.

It has been the intent of the authors to impress upon the clinician the multifaceted nature of the human pain experience. We have sought to create an understanding of the emotional nature of pain. The treatment of pain as a pure sensation without directing attention to its behavioral and psychological aspects will generally lead to failure in understanding and ultimately in treating this ubiquitous problem in our profession. The use of drugs alone will have only a minor effect on the treatment of pain. Knowledge of environmental control and an understanding and empathetic approach to the patient in pain or in stress will carry the dentist a long way toward his goal of dental treatment without pain or emotional upset.


The child and the adolescent: new rights for an "old" minority.

The use of the learning model is a necessary prerequisite for rendering dental care to the child or adolescent. The awareness of the emotional needs of the child and adolescent and the ability of the doctor to handle them is a requirement for an individual to treat these persons. The treatment plan and methods of treatment are essential factors in the behavioral management of the child or adolescent. There is a normal range for grwoth, development, and maturation in which sequences, timing, and rates of changes are critical. A cross-sectional approach in rendering care is not appropriate in learning to work with children and adolescents. The doctor who renders the care for this age group should be well versed in certain aspects of behavior, as this will affect the treatment plan and methodology, but that doctor must also have the technical abilities to do the spectrum of services to which the patient is entitled. One without the other is a definite compromise for the patient. If the doctor does not further pursue additional assistance from his colleagues, the rights of the child or adolescent have been violated.


[Pyoderma gangraenosum associated with Philadelphia-chromosome-negative chronic myeloid leukaemia (author's transl)].

Chronic myeloid leukaemia was observed 20 months after onset of pyoderma gangraenosum in a 35-year-old female. In this case an induction by cytostatic drugs could be excluded, confirming the association of pyoderma gangraenosum with leukaemias.


Variation in the Philadelphia chromosome.

Cytogenetic study of 17 cases of chronic myeloid leukaemia has shown that the Philadelphia chromosome is a variable entity, differing in size and banding pattern between individuals.


Patient evaluation.

Failure to diagnose periodontal disease is a frequent and unnecessary error. A new periodontal screening examination has been proposed that will accurately detect periodontal disease in approximately five minutes and can be incorporated into a routine dental examination. Simplified treatment planning based on the findings of the periodontal screening examination has also been proposed. Its use could significantly improve the quality of periodontal care for most dental patients.


Juvenile periodontitis (periodontosis).

Juvenile periodontitis, characterized by early age of onset, rapid rate of periodontal tissue destruction and selective tooth involvement in the absence of commensurate aetiological factors, is recognized as a distinct clinical entity. The present paper describes the clinical findings and some immunological characteristics in a group of thirty-four patients under the age of thirty. Clinical aspects studied included the influence of sex, race, family history and general health. Immunological findings relating to the level of immunoglobulins in serum and saliva, lymphocyte transformation in response to veillonella, bacteroides, fusobacterium and actinomyces species and to ultrasonicated plaque, and the inhibition of macrophage migration by these antigens. Differences were shown to exist between those patients below the age of 22 years and the group aged 23-29 years.


Cancer and the environment.

The environment is becoming an increasingly important factor in the aetiology of cancer. In addition to physical carcinogenic substances, chemical agents, in particular, are identified in ever increasing numbers as being oncongenic. This has been experimentally shown in the case of more than 1000 substances, of which 30 are also regarded as carcinogenic in humans. To be effective, aetiological research should lead to the elimination of the substances which are identified as harmful. In the present state of our knowledge, this will be a considerable contribution to prophylaxis.