Tongue and jaw muscle activity in response to mandibular rotations in a sample of normal and anterior open-bite subjects.

In order to investigate the effect of mandibular rotations in human subjects, the electromyographic activity from the left GG, left masseter, and left orbicularis oris muscles was recorded during voluntary opening movements of the mandible that were monitored by an electronic transducer. For each muscle, a computer-based system was used to calculate a threshold incisor-separation position corresponding to a 20 percent increase in base line muscle activity. The mean threshold level for the GG muscle in a sample of twenty subjects with normal occlusions was 53.0 percent (S.D. +/- 22.8)of maximum jaw opening. By contrast, a sample of nine subjects with anterior open-bite malocclusions had a statistically significant (p less than 0.001) lower mean threshold of 5.9 percent (S.D. +/- 4.5) of maximum jaw opening. No significant differences in masseter or orbicularis oris muscle activity were found between the two samples. Since postural tongue activity could play an important role in the development of the anterior dentition, the lower threshold for the GG muscle activity in response to jaw opening in anterior open-bite subjects may be of significant clinical importance.


Solubility of injectable Valium in intravenous solutions.

A study of the solubility of Valium in commonly used intravenous solutions showed Valium to be equally insoluble in 5% dextrose in normal saline, 5% dextrose in water, normal saline, and Ringer's lactate. However, the precipitate which was formed became completely resuspended when mixed with as little as 39-42% plasma in vitro. This would indicate that the chalky precipitate seen in the I. V. tubing when Valium is injected into a running I. V. near the venipuncture site becomes resuspended when mixed with plasma in vivo. If one elects to inject Valium into the tubing of a running I. V., it is recommended that the drug be administered slowly to assure adequate mixing with blood plasma in order to prevent the circulation of particulate matter.Valium is currently one of the most popular drugs used in the psychosedative management of the apprehensive dental patient. Various techniques are advocated for its administration from direct injection into a vein to injection of the drug into a running I. V. However, the manufacturer states that the drug should not be added to I. V. fluids or other solutions or drugs. Presumably this is because of the formation of a cloudy precipitate immediately upon addition to aqueous solutions. Grower et al. have shown that saturated aqueous solutions of Valium in normal saline redissolve when added to plasma; however, they presented no data on the behavior of solutions of Valium added to other commonly used intravenous fluids. The present study was, therefore, undertaken to study the behavior of Valium when added to lactated Ringer's solution, 5% dextrose solutions, and normal saline; and to see how human blood plasma affects the solubility of Valium in these solutions.


Pain sensation related to local anesthesia injected at varying temperatures.

The purpose of the study was to determine whether local anesthetic solution warmed to body temperature (37° C) produced less pain on injection than an anesthetic solution injected at room temperature (21° C) and to determine which solution resulted in quicker anesthetic onset. It was found that the subjects experienced no difference in pain during injection of warm and cold anesthetic solution given respectively in the maxillary buccal sulcus area. The time of anesthetic onset was also not influenced by solution temperature.


A longitudinal growth study: maxillary length at puberty in females.

1. A great individual variability is present in the timing of the maximum increment in ANS-PNS. 2. The maximum increment in maxillary length occurred before, as well as after, menarche, onset of epiphyseal-diaphyseal fusion, and peak of growth in height. 3. The later the maximum increment of growth occurred, the earlier menarche and onset of fusion occurred in relation to the peak. 4. The amount of growth at peak and duration of growth were not dictated by the absolute size of the maxilla at peak. 5. There was no significant difference in the amount of growth of maxillary length before or after menarche. 6. Timing of maximum increment in maxillary length was weakly correlated with onset of epiphyseal-diaphyseal fusion and menarche.


Muscle function during treatment with the functional regulator.

Thirty subjects of approximately the same age, sex, and dental and skeletal relations were divided into three groups: a control group and two treatment groups, which were studied electromyographically over periods of six months and twelve months. The dental, skeletal and electromyographic data were analyzed and charted on multibargraphs. The investigation revealed the following: 1. The Class I control subjects could be differentiated from the Class II and III subjects on the basis of differences in muscle behavior. 2. The Class II treated subjects exhibited changes significantly different from those seen in the control group in the upper lip and suprahyoid group. 3. The overall changes in the four muscle groups studied in the Class II treated subjects were characterized by a decrease in muscle activity. 4. The Class III treated subjects had changes in lower lip activity and suprahyoid group significantly different from those seen in the control subjects. 5. The Class III treated subjects, with one exception, showed an increase in muscle activity in the four muscle groups. 6. The Class II treated subjects who exhibited the greatest changes in muscle behavior also had the greatest changes in skeletal and dental relations. The opposite was true for the Class III treated subjects. It cannot be stated whether muscle pattern alterations seen in this study are coincidental with the dental and skeletal changes or vice versa. However, it is quite clear that both orofacial muscle activity and dental and skeletal dimensions are altered with the wearing of the Functional Regulator.


The significance of cephalometrics in treatment planning.

Twenty-four orthodontists were asked to provide a treatment plan for a series of six cases of malocclusion. In certain types of cases there was high or total agreement on treatment planning whether or not a cephalometric radiograph and analysis was available. In view of these findings, it may be appropriate for orthodontists to reassess their routine use of cephalograms.


Pont's Index as applied on Indians.

One hundred dental models of normal occlusion were evaluated to check the reliability of Pont's Index on a North Indian population. It was concluded by the present study that significant correlations were found to exist between the combined maxillary incisor widths and the maxillary intermolar and interpremolar arch widths.


The relationship between tooth mineralization and early radiographic evidence of the ulnar sesamoid.

The relationship between early radiographic evidence of calcification of the adductor sesamoid of the first metacarpophalangeal joint and the state of maturity of certain teeth was investigated. Data were obtained from the records of one hundred and forty children of Caucasoid origin, comprising ninety-three girls and forty-seven boys. Calcification of the adductor sesamoid was closely related to the completion of root mineralization of the mandibular canine prior to apical closure. No significant sex differences were noted in the state of maturation of the tooth in relation to this particular stage of skeletal development. Correlations among the remaining teeth studied were low, the distribution of calcification stages being widely dispersed with significant sex differences evident. Based on the findings of this study, the completion of root formation of the mandibular canine prior to apical closure may be used as a maturity indicator for the commencement of the circumpubertal growth spurt with a similar degree of confidence as the calcification of the adductor sesamoid of the thumb. It should be noted, however, that racial variations might exist in the relationship between the state of maturity of this tooth and the commencement of mineralization of the sesamoid. Caution should thus be exercised in the application of these findings to other racial groups.


The histocompatibility complex GLA in the goat.

The current status of research on the major histocompatibility complex of the goat (GLA) is discussed, as well as its similarities to other species, although some of the results are preliminary.


Biogenic amine metabolism in Tourette syndrome.

Biogenic amine metabolism in the central nervous system of 9 children with Tourette syndrome was evaluated by quantitation of their metabolites in cerebrospinal fluid by a gas chromatographic/mass spectrometric method. Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and 3-methoxy-4-hydroxyphenylethylene glycol (MHPG) were measured in CSF before and after oral administration of probenecid. Dopamine metabolism appeared defective, as both baseline and accumulated levels of HVA after probenecid were decreased. Serotonin metabolism also appeared defective in some patients with low baseline and low accumulated levels of 5-HIAA after probenecid. Taken together with other clinical features of this disease, the results suggest an underlying disorder of dopamine and serotonin metabolism in Tourette syndrome.


Cytarabine and thioguanine for acute nonlymphocytic leukemia. Another look.

A modification of the protocol of cytarabine and thioguanine was used for remission induction in patients with acute nonlymphocytic leukemia. First, synchronization of the mitotically active leukemia cells was attempted by administering cytarabine alone in a dose of 5 mg/kg of body weight 24 hours prior to initiating daily therapy with both drugs. Second, in order to recover dormant leukemic cells into the proliferative pool, both drugs were continued without interruption and without regard to the suppression of the circulating leukocyte and platelet count until bone marrow aspirates, repeated daily if necessary, were free of leukemic blast cells. This usually resulted in severe but reversible bone marrow hypoplasia, and 16 of 21 patients (76%) so treated achieved complete hematologic remission.


Is pancreatic polypeptide estimation of value in diagnosing gastrinomas (Zollinger-Ellison syndrome)?

Serum levels of pancreatic polypeptide (PP) were determined in 32 normal subjects, 18 patients with gastrinoma, 19 patients with pituitary adenoma and 11 patients with duodenal ulceration. Mean serum levels of PP in patients with gastrinomas (67 +/- 31 pmol/l (SD)) were significantly (P less than 0.01) higher than in the normal subjects (47 +/- 15 pmol/l). However, only five of 18 of the patients with gastrinomas had PP levels above the upper limit of normal and elevations of similar magnitude were observed in patients with other disease processes. It is therefore concluded that serum PP estimations are not of value in the diagnosis of gastrinomas.


The effect of cimetidine on gastrin release in ulcer disease.

The effect of a single dose of 400 mg of the H2-receptor antagonist cimetidine on protein meal stimulated immunoreactive gastrin was assessed in ten patients with gastric ulcer and ten patients with duodenal ulcer. In gastric ulcer patients, serum gastrin (mean +/- SE) rose from 34 +/- 2.2 pmol.l-1 to a peak of 80 +/- 5.0 pmol.l-1 at 45 minutes without and from 36 +/- 2.2 to 107 +/- 8.0 pmol.l-1 at 60 minutes with cimetidine; in duodenal ulcer it rose from 26 +/- 3.0 to 47 +/- 5.1 pmol.l-1 at 45 minutes without and 26 +/- 3.2 to 52 +/- 5.1 pmol.l-1 at 60 minutes with cimetidine. Integrated gastrin responses in gastric ulcer were 4900 +/- 800 pmol.l-1 120 minutes without and 7000 +/- 900 pmol.l-1 120 minutes with cimetidine and 1560 +/- 300 pmol.l-1 120 minutes without and 2620 +/- 400 pmol.l-1 120 minutes with cimetidine in duodenal ulcer patients. These gastrin increases after cimetidine are comparable to those achieved with continuous intragastric neutralisation with alkali.


Immune complexes in diabetes mellitus.

Sera from 86 well controlled diabetics were examined for the presence of immune complexes. Thirty-six patients were receiving standard insulins, 19 monocomponent preparations, 24 oral hypoglycaemic agents and seven dietary restriction alone. Three methods were used to detect complexes: measurement of complement components, a Clq binding assay (BA) and the Raji cell radioimmunoassay (RIA). Complement components were normal in all patients. Eleven (31%) of the group on standard insulins had a positive Raji cell RIA; none had an abnormal Clq-BA. One patient on monocomponent therapy had a mildly positive Raji cell RIA; Clq-BA was negative in each patient of this group. Thirteen (54%) of the patients on oral hypoglycaemic agents were positive on one or both assays while one patient on diet alone was abnormal on both assays. These data show that immune complex production is common in both insulin-requiring and non-insulin-requiring diabetics and that this phenomenon is strikingly less frequent in patients on monocomponent insulins. Such observations could bear relevance to the pathogenesis of microvascular complications in diabetes.


Heparinized chemotherapy in the treatment of disseminated lung cancer.

Fourteen patients with inoperable or metastatic carcinoma of the lung were entered in this study. All of them received one or more courses of multiple chemotherapy (cyclophosphamide, 5-fluorouracil, methotrexate and vincristine) with prior and concurrent heparin anticoagulation. No tumour regression was noted in any patient although one patient is alive and well at two years. Five patients developed sudden increase in pleural effusion whilst on heparin therapy and in four of these patients the effusion was a significant factor in their death.


Hodgkin's disease terminating in acute leukaemia: report of seven cases.

Acute nonlymphocytic leukaemia developed in seven patients treated for Hodgkin's disease. All had received intensive radiotherapy and chemotherapy. One patient had clinical evidence of active Hodgkin's disease at the time of diagnosis of acute leukaemia, and of four other patients who had a post mortem examination another showed evidence of Hodgkin's disease. The median time from the first presentation with Hodgkin's disease to the development of acute leukaemia was 7.7 years. Chromosomal abnormalities were found in four patients. A preleukaemic phase was present in three patients. Survival following diagnosis of acute leukaemia was short (median four weeks) and only one patient achieved a complete remission. Although published data suggests that radiation exposure is an important aetiologic factor in the induction of acute leukaemia in patients with Hodgkin's disease, it appears likely that additional chemotherapy may have a significant potentiating effect.


Bundle branch block after myocardial infarction--a long term follow-up.

Fifty-two patients with myocardial infraction complicated by bundle branch block (27 RBBB and 25 LBBB) survived the hospital period (1967--1972), and were followed up to December 1976. Actuarial survival curves revealed a worse mortality up to five years (P less than 0.05) for LBBB (68%) than for RBBB (33%). All deaths occurred in the first four years. In RBBB, additional hemiblock (seven patients) did not increase the risk of heart block nor worsen the prognosis--one death in seven patients (14%) compared to eight in 20 patients with isolated RBBB (40%). The previous literature on long term survival of BBB was reviewed. Recommended treatment for BBB, a marker of severe myocardial damage, includes antiarrhythmic prophylaxis for anteroseptal infarction with RBBB, aneurysmectomy in selected subsets of patients, and possibly prevention of RBBB or its complications by treatment for reduction of infarct size during the very early phase after onset of infarction.


Bronchial reactivity in Western red cedar induced asthma.

A patient with Western red cedar induced asthma is described. The diagnosis was confirmed by a bronchial challenge with Western red cedar saw dust and the subsequent prolonged bronchial reactivity changes were measured using histamine inhalation tests.


Improvement of left ventricular function in alcoholic cardiomyopathy documented by serial gated cardiac pool scanning.

Serial gated cardiac blood pool scans showed a gradual return to normal left ventricular function over ten months in a 44-year-old patient who presented initially with severe alcoholic congestive cardiomyopathy. The clinical signs of left ventricular failure abated considerably before myocardial function improved objectively on gated blood pool scanning.


Radiation-related coronary artery disease in Hodgkin's disease.

Coronary artery disease is a rare and only recently recognised complication of mediastinal irradiation. A 34-year-old man died suddenly eight years after mediastinal irradiation for Hodgkin's disease. Autopsy disclosed severe narrowing of all major extramural coronary arteries by atherosclerotic plaques whereas all other systemic and visceral arteries were virtually free of atheroma. Autopsy findings in the five reported cases of radiation-related coronary artery disease are reviewed.


Necrotising enterocolitis associated with invasion by Clostridium septicum complicating cyclic neutropaenia.

A fatal case of necrotising enterocolitis complicating cyclic neutropaenia in a 17-year-old boy is reported. The episode of enterocolitis was characterised by fulminant, generalised peritonitis associated with necrosis and gas formation in the wall of the ileum and caecum. Clostridium septicum was grown from premortem blood cultures and Gram positive bacilli typical of this organism were present in histological sections of the bowel wall. Necrotising enterocolitis in this and previously reported cases of cyclic neutropaenia resembles the agranulocytic form of intestinal necrosis which occasionally complicates leukaemia.


67Gallium uptake in psittacosis infection.

67Gallium citrate isotope scanning was performed in a febrile patient with pneumonitis and hepatitis who was later shown to have psittacosis. Focal isotope uptake was detected in both lungs in the absence of radiological changes. There was no enhanced concentration in the liver where inflammatory cell infiltration was slight.


Disseminated cryptococcosis with ocular involvement.

A case of disseminated cryptococcosis with extensive ocular involvement is reported. The patient had pulmonary, meningeal, cerebral, cutaneous, lymph node, renal, adrenal and thyroid lesions, as well as granulomatous endophthalmitis.


A study of synovial fluid and cytology in arthritis associated with herpes zoster.

A case of herpes zoster complicated by acute arthritis with effusions is described. The white cell count in the synovial fluid was low, with a predominance of neutrophils. The synovium showed superficial deposits of fibrin, slight intimal hyperplasia, and subintimal polymorph infiltration. Varicella virus was not detected by culture or electron microscopy, but varicella antigen was demonstrated in the cytoplasm of macrophages in the effusion. Other findings did not determine whether the antigen had appeared in the joint from circulating immune complexes, or following synovial phagocytosis or proliferation of virus.


Inhibitory epilepsy.

Unlike post-epileptic paralysis, inhibitory epilepsy is rare and not well known. Differentiation between the two phenomena is usually difficult because both may have associated seizures. A satisfactory physiological explanation has yet to be advanced to account for the paraplysis. The present is a report of such a case together with the results of electroencephalographic, electromyographic and nerve conduction studies both during and after an attack of paralysis. The results suggest that inhibitory impulses originating from higher centres acting on the upper motor neurone itself leaving the anterior horn cell and possibly the upper motor neurone input to the gamma efferents switched off, are probably responsible for the paralysis.


Axial muscle and myocutaneous flaps: a recent concept in wound closure.

Until the last decade, the greatest advances in reconstructive surgery have been skin grafting and the advent of pedicle flaps. More recently a new understanding of the discrete vascular anatomy of the skin and other composite tissues has enabled the transfer of these tissues with far more reliability, either locally or--using microvascular techniques--to a distance. The axial and random concept of blood supply of flaps will be outlined. A brief historical background of the development of axial flaps is included. A synopsis of the anatomy, uses and limitations of the commonly used and proven muscle and myocutaneous flaps in our experience is reported. In the final discussion, a new and simple classification of wound closure is proposed which encompasses all the recent developments in this field.


Subcutaneous mastectomy: indications and technique.

For a certain group of patients, carefully selected by criteria which are here discussed, subcutaneous mastectomy offers a real prospect of minimizing the risk of breast cancer developing. It will also relieve pain in most of those for whom it has become intolerable and will usually provide the patient with both comfort and peace of mind. Performed by the technique described, subcutaneous mastectomy can now produce an aesthetically pleasing result. Regular review of all patients is, however, mandatory.


Subcutaneous mastectomy using an inferior nipple pedicle.

A technique for subcutaneous mastectomy is described which permits a reduction mammoplasty or mastopexy to be performed at the same time. The nipple is based on an inferior dermal pedicle. This appears to provide a safe blood supply to the nipple and safe cover for the prosthesis. The dermal pedicle for the nipple reinforces the submammary suture line and lessens the chance of extrusion of the prosthesis.


The surgical pathology of breast cancer in relation to reconstruction after mastectomy.

Pathological features such as tumour type, tumour size and lymph node invasion have an important bearing on the prognosis of the patient with breast cancer. It is suggested that such prognostic factors should be considered in the selection of women for post-mastectomy breast reconstruction. The implications of pathological and other factors are reviewed and a summary of favourable prognostic factors is presented.


Primary isolated extramedullary plasmacytoma of the duodenum.

The first case of primary isolated extramedullary plasmacytoma (EMP) of the duodenum is reported. The features which differentiate primary isolated EMPs from EMPs associated with multiple myeloma are discussed. The prognosis for a primary isolated EMP of the gastrointestinal tract is uncertain.


Spontaneous perforation of the common hepatic duct: a new presentation.

A case is reported of spontaneous perforation of the common hepatic duct in a patient presenting with a six-day history of painless jaundice and a one-day history of nausea and vomiting. An endoscopic retrograde cannulation of the common bile duct revealed a large stone in the distal end of the grossly dilated biliary tree. At operation a large collection of bile, sealed off by omentum, was found beneath the liver. A perforation was present in the common hepatic duct close to its junction with the cystic duct.


Caecal herniation through the foramen of Winslow.

The 28th reported case of caecal herniation through the foramen of Winslow is presented. A review of the literature reveals a mortality of 49% in lesser-sac herniae due to late diagnosis and operative difficulties. The comparative ease of hernial reduction after deflating trapped bowel by small-bore needle aspiration is discussed.


Femoral nerve block: a simple and safe method of instant analgesia for femoral shaft fractures in children.

A simple safe technique of providing rapid, effective analgesia in children with femoral shaft fractures is described. It is particularly useful in patients who have associated head or abdominal injuries in the presence of which opiates should be withheld. The technique is recommended to all practitioners involved in the early care of femoral shaft fractures.


A survey of women with unplanned exnuptial pregnancies in Brisbane.

The social circumstances of women with exnuptial unplanned pregnancies were surveyed, and the differences between those continuing with their pregnancy and those who decided to terminate their pregnancy were compared. Women who continued their pregnancies were younger, poorer, less educated, and more likely to be employed in unskilled jobs when compared with those who decided to have their pregnancy terminated.


Shoulder dystocia: a study of 47 cases.

Shoulder dystocia at vaginal delivery occurred in 0.2% of cases. Antenatal prediction of this complication was very difficult. In primigravidae in labour, delay late in the first stage was a warning sign; induction of labour, the use of regional analgesia, and forceps delivery for delay in the second stage of labour were associated with subsequent shoulder dystocia, although a cause-effect relationship was not established. The immediate maternal and fetal morbidity were high, nearly 30% of the babies suffering from a severe neural or bony injury. Forty-four per cent of the babies were beyond 41 weeks of gestation, and 70% weighed over 4,000 g. The avoidance of postmaturity by elective induction of labour at 41 weeks of gestation would significantly reduce the incidence of shoulder impaction at delivery.


A technique for management of obstructed labour with antenatal fetal death.

A technique for management of obstructed labour associated with fetal death is presented. The new method makes it possible to decrease fetal head size by evacuation of brain tissue by suction using thoracic-type trocar. Three patients with obstructed labour and fetal death were managed successfully using this technique. The method permits a decrease of fetal head size easily and rapidly, avoiding the risks of other techniques. Moreover, its use makes it possible to eliminate craniotomy from obstetric practice. The method should be equally suitable for cases of major hydrocephaly.


The immunobiology of placentation.

A review of the current theories on the nature of the placental allograft and the evolution of placentation in the presence of a cellular immune response highlights the inability of current hypotheses to explain the success of both invertebrate and vertebrate placentation. Only one theory -- "the anatomical separation of the fetus from the mother" -- appears relevant. How this separation might develop during implantation is discussed.


An endocervical speculum.

An endocervical speculum has been devised for use with the colposcope in the evaluation of abnormal cytologic smears. It allows inspection of the endocervical canal and helps delineate the uppermost limits of the dysplastic and/or CIS lesion in those patients in whom it extends into the endocervical canal.


Seven years experience in the evaluation and management of patients with urge incontinence of urine.

In 1970 the authors established a specific clinic at the Royal Women's Hospital in an attempt to evaluate the causes of urinary incontinence, to improve the follow-up of patients treated for this complaint, and to determine areas where treatment was deficient. Of 258 patients seen in the clinic so far 80 (31%) were considered to have had stress incontinence, 84 (33%) urgency, and 82 (32%) both symptoms. Incontinence of urine with exertion was common in patients with urgency and furthermore, the Bonney test of urethral elevation was of no value in distinguishing stress from urge incontinence. Therapy with Probanthine 15 mg t.d.s. and Tofranil 25 mg t.d.s. was effective in 127 patients (90%) in whom urgency was the sole or dominant complaint.


Proliferating ovarian "epithelial" tumours: a clinico-pathological analysis of 144 cases.

In a 25-year period, 144 patients with proliferating epithelial ovarian tumours were treated at the King George V Memorial Hospital. These tumours were classified according to the World Health Organisation (WHO) Histological Classification of Ovarian Tumours and subsequently divided into 4 grades of proliferation, again on histological criteria. The tumours were staged at laparotomy in accord with the recommendations of the International Federation of Gynecology and Obstetrics (FIGO). Follow-up data, analysed by a life-table method, were correlated against histological type of tumour, histological grade of proliferation, clinical/laparotomy stage, and mode of surgical therapy. Stage 1 proliferating tumours may be treated by surgery alone, including unilateral salpingo-oophorectomy in selected cases. Stage 2 and Stage 3 tumours should be treated similarly to invasive ovarian carcinomas of the same stage, despite their overall favourable prognosis.


Water intoxication and Syntocinon infusion.

A case of severe water intoxication with convulsion and prolonged coma, following the use of a high dose Syntocinon infusion is described. The pathogenesis and treatment of the condition are discussed.


A large cyst of Skene's duct -- a rare cause of superficial dyspareunia.

A case is reported which illustrates a rare cause of external dyspareunia, probably of Neisserial origin, and satisfactorily resolved by surgical extirpation. The morphological and embryological significance of the Skene's duct and related cysts are discussed.


Factors influencing the time of introduction of steroidal contraception in the breast-feeding mother.

To ensure infertility whilst breast feeding many mothers ingest steroidal contraceptives. Animal experiments have shown how sexual differentiation of the brain occurs during perinatal life and can be affected by exogenous steroids. The amount of sex steroid secreted in the milk of lactating mothers is very small and dependent on the type of steroid chosen. "On demand" breast feeding is associated with a longer period of lactational amenorrhoea, obviating the necessity for early usage of contraceptives. In view of the possibility that sexual differentiation may be disturbed, it is suggested that, where steroidal contraception is required, the progesterone with the minimal amount of oestrogenic metabolite be used.


Investigation and management of symptomatic hyperprolactinaemia.

Fifteen patients with infertility and hyperprolactinaemia have been investigated using tests of prolactin and LH secretion, and treated by prolactin suppression. In addition, 4 patients with hyperprolactinaemia not desiring fertility were also investigated. Of the total group, 16 had galactorrhoea and 15 had amenorrhoea. Pituitary tumours were present in 6 patients and 4 had pituitary microadenomas. Prolactin levels measured by both radioimmunoassay and radioreceptor assay were elevated before treatment and fell during therapy with bromoergocryptine (7.5 mg daily). Tests of prolactin release with TRH and chlorpromazine before treatment did not distinguish patients with functional hyperprolactinaemia from those with pituitary tumours. Basal plasma gonadotrophin concentrations were not elevated despite subnormal urinary oestrogen levels. The serum LH response to LRH was normal during hyperprolactinaemia, but LH release in response to oestrogen provocation was impaired in 14 of 17 patients. During prolactin suppression, mean oestrogen excretion rose significantly and the oestrogen provocation test became normal in all except 2 patients. Pregnancy occurred in all of the 15 patients desiring fertility. Abortion has occurred in 4 patients, all of whom are currently pregnant again. Nine pregnancies have reached term, with no complications from pituitary expansion. It appears that during hyperprolactinaemia there are defects in both positive and negative feedback of oestrogen on LH secretion, and that prolactin suppression in such patients is highly effective in restoring fertility.


Menstrual characteristics of 2,343 women attending the Shepherd Foundation.

Menstrual characteristics of 2,343 women attending the Shepherd Foundation Health Testing Centre have been analyzed utilizing a computer system of data analysis. The incidence of menstrual pain was 43% and premenstrual tension 75%. The best estimate of normal cycle length was 21-35 days, 1.5% of women having cycles less than 21 days. The duration of menstrual loss was 1-7 days, 3% of women bleeding for more than 7 days. Utilizing the various responses to questions concerning menstrual and cycle length, menstrual pain and premenstrual tension, 150 patterns were found, the 10 most common patterns accounting for 40% of the population; most of the latter patterns included menstrual pain and premenstrual tension. Authorities disagree upon the definitions of normal menstruation and there are serious implications from the lack of knowledge in this area, both for the individual patient and the cost of health care. The formation of a health committee to determine national standards for defining normal menstruation is advocated.


Social and psychological factors in relation to premenstrual tension and menstrual pain.

Age, country of birth, marital status, attitude to work, smoking and drinking habits, childbearing, sex life and psychological factors are all linked to the frequency of menstrual pain and premenstrual tension. The relationship between the psychosocial and menstrual characteristics may be causal or related to some other constitutional factor (or factors) which determines both. The profile of women suffering from premenstrual tension and menstrual pain is described. In management, associated psychosocial factors and the relationship betweem these and the described menstrual problems needs to be taken into account.


Spontaneous rupture of the spleen in late pregnancy.

Two cases of spontaneous rupture of the spleen are described. The first patient presented with fetal distress in the second stage of labour; the second with hypovolaemic shock. Both mothers and babies survived.


Giant condyloma acuminatum of the vulva and anal canal.

This publication describes the second known reported case of benign giant condyloma acuminatum of the vulva and anal canal (Buschke-Loewenstein tumour). The diagnosis of squamous cell carcinoma was made initially on clinical examination and could not be excluded by punch biopsy. A full pathological study of the tumour established the diagnosis. A defunctioning colostomy and a perineo-ano-vulvectomy with groin gland dissection was performed and the patient is free of disease 36 months later. The biology of this type of tumour is discussed.


A simple operation for postcoital urethrotrigonitis in women.

Definitive treatment of postcoital urethrotrigonitis, or "honeymoon cystitis", as it is commonly called, has only been paid serious attention since 1967. It has been suggested (O'Donnell, 1959) that the introduction of bacteria into the urethra is more likely when the urethra assumes a relatively hypospadiac position during coitus. This is commonly associated with incomplete rupture of the hymen. Division of the anterior bridge of the hymen on either side of the external urethral meatus appears to be as effective as more complicated procedures in preventing ascending infection associated with coitus.


Value of total serum oestriol and human placental lactogen in the assessment of fetal-placental function.

Serum levels of total oestriol and human placental lactogen (HPL) were measured in 360 pregnancies; in 182 there were abnormalities likely to be associated with increased fetal risk. A total of 217 estimations of oestriol and HPL were performed in 163 normal pregnancies to define the normal ranges. The value of both tests in the management of complicated pregnancies was assessed. Serum oestriol was found to be very efficient in the diagnosis of intrauterine growth retardation. In such cases, 76% of patients had unfavourable oestriol levels. Patients with mild pre-eclampsia had HPL levels similar to normal, but values decreased significantly in the presence of fetal distress. The mean serum oestriol level in patients with pre-eclampsia were lower than normal, and were further reduced in the presence of fetal distress. The importance of measuring serum oestriol levels at each antenatal visit is stressed in the detection of developing fetal complications; in such cases, 73% of patients had subnormal values. Both tests provided accurate assessments in the 8 patients with intrauterine death. Significant fetal-placental dysfunction was present in 55 patients, and 41 (75%) were predicted by serum oestriol, 23 (42%) by HPL, and 45 (82%) by the use of both tests. In the 142 complicated pregnancies that resulted in a favourable outcome, confirmation was obtained in 102 (72%) by serum oestriol and in 121 (86%) by HPL.


Routine fetal maturity estimation by ultrasound.

The accuracy of ultrasonic estimation of fetal maturity and, therefore, the delivery date is greatest when the biparietal diameteris less than 5.0 cm and least when it is greater than 9.0 cm. A comparison of the accuracy of ultrasonic and last menstrual period based estimations of the delivery date revealed that there is no significant increase in accuracy for ultrasonic estimations when the biparietal diameter is less than 9.0 cm, but when the diameter is greater than 9.0 cm the accuracy of delivery date estimation is significantly less than that based on the last menstrual period. In pregnancies complicated by uncertain dates, recent hormonal contraception, bleeding in early pregnancy, or an irregular or prolonged menstrual cycle, ultrasound is significantly more accurate in predicting the delivery date. Ultrasonic examination for fetal maturity is indicated only when there are clinical indications such as uncertain dates for some reason or when there is fundal height discrepancy.


A comparison of early fetal growth curves.

The curves of the growth of the maximum fetal diameter and the biparietal diameter before 20 weeks of gestation, measured by ultrasound and derived from a New Zealand population, are presented. They are compared with other published growth curves and reveal that in the New Zealand population there is a greater variation from the mean. In the case of the maximum fetal diameter there is a significantly lower mean after 10 weeks of gestation.


The relative value of the non-stress and stress cardiotocograph: a protocol and pilot study.

A simple and safe protocol is described for the conduct of a controlled comparison of the relative predictive values of the antenatal cardiotocograph in the absence and in the presence of artificial stress (oxytocin challenge) to the fetus. Each patient serves as her own control, the tests are performed on the same day, and labour also commences on the same day, so that fetal performance in labour and status at birth are closely related in time to both tests and provide a reasonable assessment of the relative value of the tests. A pilot study of 83 patients has been carried out and the results are presented.


Significance of amniotic fluid glucose in late pregnancy.

Glucose levels were estimated in over 150 amniotic fluid samples and were found to fall with advancing gestational age. Significantly lower levels were found in post-term pregnancies and in association with fetal growth retardation. Amniotic fluid glucose estimation was found to be superior to human placental lactogen in distinguishing between normal pregnancies and those complicated by fetal growth retardation. The role of the membranes in influencing the level of amniotic fluid glucose was investigated using in vitro perfusion experiments. The permeability of the membranes to glucose decreased with advancing gestational age.


Prolactin secretion during prolonged lactational amenorrhoea.

Basal serum prolactin levels were elevated up to 66 weeks postpartum in lactating amenorrhoeic women. The serum prolactin level in fully breast-feeding women was significantly higher than in women who were partially breast-feeding. The mean basal serum prolactin level in menstruating, lactating women was significantly higher than the mean level in women who had weaned and had normal menstrual cycles. The rise in prolactin due to suckling was seen up to 66 weeks postpartum. The marked variability and lack of reproducibility of individual suckling responses may obscure the importance of prolactin secretion in the postpartum period. Nevertheless, this study confirms that prolactin secretion is increased in women with prolonged lactational amenorrhoea.


Cellular sensitization in chronic myeloid leukaemia patients to leukaemic blast antigens.

Sixteen chronic myeloid leukaemia (CML) patients in remission were tested with solubilized membrane antigens from CML leukaemic cells, CML blasts, AML blasts and ALL blasts for cellular immunity in vitro by lymphocyte transformation (LT) and leucocyte migration inhibition (LMI) assays. Twelve CML patients in remission were tested with allogeneic PHA-transformed normal lymphoblasts. As controls, peripheral-blood leucocytes from 9 healthy persons were tested with the same antigen preparations. It was seen that 8/16 (50%) CML patients responded to CML antigens by both LT and LMI assays, while 5/16 (31%) patients reacted to CML blasts and 44% (7/16) patients reacted to AML blast antigens. It was interesting to note that 5/11 (45%) CML patients reacted to ALL blast antigens by both assays. One out of 12 patients reacted to PHA-transformed lymphoblasts. None of the healthy controls reacted to leukaemia-associated antigens. The results suggest the sharing of antigens between myeloid leukaemic cells, myeloid blasts and lymphoid blasts.


Patterns of maturation in short-term culture of human acute myeloid leukaemic cells.

Leukaemic cells taken from the blood of patients with acute myelogenous leukaemia (AML) frequently proliferate in suspension culture without the addition of growth factors for a limited period only. After a 6--10-fold increase in total cells, cell numbers remain constant for a time and finally decline. The main cause for this limited growth in vitro is not, initially at least, cell death leading to a steady state, but maturation associated in its final stages with cessation of DNA synthesis. Two populations of AML cells from Patients St and Wi respectively were studied, and progressive maturation towards mature leucocytes was demonstrated by the gradual acquisition in culture by the growing blast cells of intracellular enzymes (lysozyme, arginase, acid phosphatase and esterase being measured), surface markers (Fc and C3 receptors), of lactoferrin by Wi cells and of colony-stimulating activity by St cells, as well as changes in Ia antigens, phagocytic properties, morphology and adhesiveness to plastic. With St cells, which carried a characteristic chromosome marker, maturation terminated in cells with the characteristic properties of macrophages. At an intermediate stage, non-adherent and still-dividing St cells acquired Fc and C3 receptors and enzymes characteristic of monocytes. Wi cells progressively became neutrophil-like, and again there was an intermediate population of dividing cells which had Fc and C3 receptors and proteins such as lactoferrin and esterases. characteristic of neutrophils.


Spontaneous regression of human acute myeloid leukaemia xenografts and phenotypic evidence for maturation.

A population of human AML cells which have a characteristic karyotypic marker was cryopreserved and then grown in short-term liquid culture for 2 weeks, during which time the cells increased about 7-fold in number and progressively acquired characteristics of macrophages. 10(7) cells obtained after 1 day in culture, when they were almost devoid of Fc receptors (Fc-), on inoculation into immune-deprived mice gave rise to tumours in more than 90% of the animals. However, after 13 days of culture, when almost all the cells had Fc receptors (Fc+), a similar inoculum did not grow as tumours. After 7 days in culture the cells were heterogeneous, and divided about equally into Fc+ and Fc- cells, both of which were replicating. The Fc- population was capable of producing tumours, whereas the Fc+ was not. Of 23 assessable xenograft tumours produced by the AML cells, 14 regressed completely, 4 grew progressively and 5 grew progressively after initial regression. Progressive tumours could be further transplanted. The regression may arise as a result of maturation in vivo similar to that seen in vitro.


Influence of the hypoxic cell sensitizer misonidazole on the proliferation of well-oxygenated cells in vitro during prolonged exposure.

Analysis of time-lapse cinematographic film permitted the construction of pedigrees from 88 well oxygenated cells of a mouse osteosarcoma (MOS). These cells have been chronically treated with various concentrations of the hypoxic cell sensitizer misonidazole (MIS) over periods of up to 96 h. At concentrations of 0.5 and 7 mM there is a 2--3 h increase in cell-cycle time. Concentrations of 2 mM show an intermitotic time delay of 7.6--10.3 h. At 4 mM cells divided only once. With increasing drug concentration there was an increase in the number of abnormal mitoses. These results were compared with cloning efficiency (PE) experiments. PE at 0.5 mM is 80%, at 1 mM 40 and at 2 mM is reduced to 4%. Cells treated with 2mM MIS over a period of 28.6 h resume their normal cycle when the drug is washed from the culture. This may indicate that DNA is not a major target for MIS. It is concluded that this hypoxic cell sensitizer is also toxic for MOS cells in well oxygenated conditions.


t(8;14) translocation in a Burkitt's type of lymphoblastic leukaemia (L3).

Cytogenetic findings on five patients with ALL Burkitt's type are reported. A t(8;14) (q23;q32) translocation identical to that found in Burkitt's lymphoma cells was found in each case. The relationship between ALL, L3 type and Burkitt's tumours is discussed.


The composition and fluidity of normal and leukaemic or lymphomatous lymphocyte plasma membranes in mouse and man.

The lymphocyte surface membranes from normal and leukaemic or lymphomatous cells from man and mouse were isolated, characterized, and analyzed both biochemically and by diphenyl hexatriene fluorescence polarization. The cholesterol/phospholipid molar ratio for all the pure lymphocyte plasma membranes was 0.45--0.50, and the fluorescence polarization results showed that values much higher than this were not credible. The lipid composition of all the plasma membranes was remarkably similar, except for the concentration of free fatty acids and glycerides. The latter two were particularily high in the mouse lymphoma membrane and these, rather than a low cholesterol concentration, were responsible for the increased fluidity of the cells. The most prominent protein in most of the plasma membrane preparations was actin. This is found only by some authors, and its presence probably depends on the method of lymphocyte disruption.


Studies on the mechanism of action of hexamethylene bisacetamide, a potent inducer of erythroleukemic differentiation.

Hexamethylene bisacetamide (diacetyldiamino hexane) is a potent inducer of erythroid differentiation in murine erythroleukemia cells. Hexamethylene bisacetamide and the closely related pentamethylene bisacetamide were synthesized with radioactive labels in various portions of the molecule and the uptake, metabolism, and intracellular distribution determined. Bisacetamides are taken up by the cell; an intracellular concentration equal to the extracellular concentration is achieved by 6-8 h. Commitment to differentiation is not detected until at least 10 h after equilibration. Both uptake and commitment to differentiate are concentration and temperature dependent. The majority of the compound is deacetylated upon cell entry and the acetate portion incorporated nonspecifically into lipid and protein. Acetate competes with the incorporation of hexamethylene bisacetamide into protein and lipid, but does not affect inducing activity. The diamine portion of the molecule is detected only in the cytoplasm, in a trichloroacetic acid-soluble and acetylated form, whereas the acetate moiety is detected in both cytoplasm and nucleus and in both a trichloroacetic acid-soluble and insoluble form. The cellular uptake of diamines and bisacetamides (acetylated diamines) are similar, but acetylation of the diamine greatly increases inducing activity.


A Parkinson-like syndrome as side effect of chemotherapy with vincristine and adriamycin in a child with acute leukaemia.

A 9 month old boy with acute lymphoblastic leukaemia developed signs compatible with an extrapyramidal lesion (rough tremor of the skeletal muscles, more pronounced on the left side, with hypotonia and reduced cutaneous reflexes). This problem started 4 days after the second weekly course of chemotherapy with Vincristine (1.5 mg/m2) and Adriamycin (25 mg/m2) and lasted with varying intensity until death 4 weeks later. Toxicity of either drug (or both) to the central nervous system was invoked as a likely explanation and Vincristine was considered to be more likely condidate for that effect.


Quantitation of human thymus/leukemia-associated antigen by radioimmunoassay in different forms of leukemia.

Using a radioimmunoassay, increased levels of a human thymus/leukemia-associated antigen (HThy-L) have been detected in leukemic cells and plasma from most patients with E-rosette-positive acute lymphoblastic leukemia (ALL) and a number of patients with E-rosette-negative ALL, acute myeloblastic leukemia (AML), acute monomyelocytic leukemia (AMML), and acute undifferentiated leukemia (AVL). Low levels of HThy-L have been demonstrated in white cells from patients with chronic myelocytic leukemia (stable phase) and in mononuclear cells from patients with chronic lymphatic leukemia. The relationship between HThy-L and differentiation of hematopoietic cells is discussed.


The coexistence of acute myeloblastic leukemia and diffuse histiocytic lymphoma in the same patient as demonstrated by multiparameter analysis.

Measurement of cellular DNA content by flow cytometry demonstrated presence of two distinct aneuploid neoplasms in a patient who developed acute myeloblastic leukemia (AML) 4 mo after diagnosis of a diffuse histiocytic lymphoma (DHL). A lymph node aspirate contained peroxidase-negative, "null," hyperdiploid (2.6C) DHL cells, while the bone marrow (BM) contained 84% primitive peroxidase-positive tetraploid AML cells (4.0C). Minor populations of hyperdiploid HDL and normal diploid cells could be detected by flow-cytometry in the BM, and all three populations were also seen in the peripheral blood.


Erythroleukemia following drug induced hypoplastic anemia.

Three patients with drug-induced hypoplastic anemia terminating 2 to 6 years after presentation with erythroleukemia are described. All were treated for prolonged periods with androgen and corticosteroid and two of the patients showed apparent dependence on this therapy for optimal hematologic status. The leukemic phase was heralded by loss of this dependence and development of sideroblastic dyserythropoiesis with progression to bizarre erythroid hyperplasia and fatal cytopenia. The exact relationship between androgen and corticosteroid therapy and the erythroleukemia remains speculative.


Disseminated coagulopathy in chronic myelomonocytic leukemia.

The clinical and laboratory features of nine patients with chronic myelomonocytic leukemia are described. Hepatic or splenic enlargement accompanied by an absolute monocytosis in an older patient with an elevated serum or urine lysozyme and serum vitamin B12 levels were characteristic of the majority of patients in this series. No single clinical or laboratory finding was diagnostic for the disease. Most importantly, seven of nine patients had abnormal coagulation values; in two cases the abnormalities were consistent with disseminated intravascular coagulation and correlated with a hemorrhagic diathesis. It is concluded that patients with chronic myelomonocytic leukemia who have thrombocytopenia or a bleeding tendency should be evaluated for evidence of disseminated intravascular coagulation.


Alkaline phosphatase levels in osteosarcoma tissue are related to prognosis.

Levels of alkaline phosphatase were measured in the primary tumor of 26 patients with osteosarcoma. One of seven patients with a tissue alkaline phosphatase level less than 0.6 microM/min/mg developed pulmonary metastases. In contrast, 16 or 17 patients with a tissue alkaline phosphatase level greater than 0.6 microM/min/mg developed pulmonary metastases. It thus appears that tissue alkaline phosphatase levels of primary osteosarcomas are strongly correlated with prognosis (p less than .01).


Vincristine-methotrexate combination chemotherapy and the influence of weight loss on experimental tumour growth.

According to pharmacokinetic reports, vincristine administration should precede methotrexate therapy. Our sequential treatment of L1210 leukaemic mice, in which vincristine was administered before methotrexate therapy, was as effective as treatment with the two drugs given simultaneously. In solid tumour experiments we were unable to show any increase in the antitumour effect of methotrexate when vincristine was injected before methotrexate administration. Consequently, we advocate the re-evaluation of the practice of vincristine leads to methotrexate therapy as used in many clinical protocols for the treatment of patients with osteosarcoma. Pretreatment with vincristine resulted in methotrexate-induced weight loss and sometimes in toxic death of the mice. Since the growth of tumours can be modified by regulation of the caloric intake of the host, this aspect was investigated in more detail. The effect of starvation, which was comparable to the effect of drug-induced weight loss, had a retarding effect on tumour growth. The growth rates of smaller tumour volumes were less severely affected than were those of large tumour masses.


Unpredictable serum levels after oral methotrexate in children with acute lymphoblastic leukaemia.

Serum methotrexate levels were measured for 5 h after oral intake in 11 children with acute lymphoblastic leukaemia. The curves obtained with the child's regular dose of methotrexate varied widely, and were independent of the doses used. Peak levels were found in samples taken up to 3h after ingestion, and ranged from 300 to 1250 ng/ml. In the doses used, methotrexate toxicity was present in one of the eleven children, and was associated with a delayed peak and a high 5-h methotrexate level. Individual drug metabolism could be an important factor in the response to treatment, and needs to be evaluated in the assessment of protocols.


A prospective study of the rehabilitation of the above-knee amputee with rigid dressing. Comparison of immediate and delayed ambulation and the role of physical therapists and prosthetists.

Twenty-four above-knee amputees (AKA) treated with rigid plaster dressings were randomized to receive ambulation on pylon within 24 hours of surgery or at time of suture removal. Casts were applied by physical therapists in half of each group, and by a prosthesist in the other half. There were no statistically significant differences among the groups with respect to age, sex, stump length, gait characteristics and wound healing. Time to prescription of final prosthetis was similar in all groups. Specifically, there was no delay in the group ambulated immediately. The immediate ambulators did have significantly greater stump pain requiring more analgesia than the group ambulated after suture removal. Patients with case applied by physical therapists used their prostheses more than patients with cases applied by prosthetists. There was no detectable difference among treatment groups with regard to participation in therapy, acceptance of prosthesis, and psychological status. Recommendation for management of AKA's include: use of rigid dressing; ambulation on pylon after suture removal; utilization of physical therapist for application of rigid dressings and alignment of pylon.


[Marginal cleft and solubility].

Studies of extracted teeth showed that, when the width of the interval is increased by 0.1 mm, the depth of the interval enlarged an average of 0.067 mm. It would seem that, in terms of cement caries, the attachment cement loosens more quickly under the effect of carious processes. The loss of substance is less when the cement seams are below the gingival cuff. Laboratory tests of cement seams showed the loss of substance to be slight with zinc-oxide-phosphate cements. A distinct shrinkage was observed with carboxylate cements. The greatest amount of loss was reported with the EBA cement.


[Fluidity of casting materials in plane spreading].

The high fluid elastomer materials for making casts used for the double impression technique were studied with the so-called disc test in terms of their fluidity, diffusion, and layer thickness. The pressure exerted was also recorded at the same time. Our study showed that the low viscosity of the cast material and the application of small amounts were the prerequisites for obtaining the thinnest layer possible.


[Dosage and viscosity of carboxylate cements].

The optimal ratio between powder and fluid cannot be obtained in most cases with the dosage suggested in the manufacturers instructions for carboxylate cement. The mixtures usually do not contain enough powder. Pouring tests showed the processing period to be longer. The processing time is shortened by heating the cement to mouth temperature (37 degrees C) after mixing.


[Bending resistance and bending module of 2 photopolymerizing plastic filling materials].

Bending tests corresponding to the German Industrial Norm 13,922 for plastic filling material were carried out with ultraviolet polymerized Nuva-Fil P.A. and photopolymerized Fotofil. The photopolymerized Fotofil fulfilled the German Industrial Norm requirements: at least 50 N/mm2 bending impact strength after 24 hours. After longer periods of time, however, bending impact strength dropped below 50 N/mm2. The difference between Fotofil and other composites was obvious. The use of Fotofil together with increased bending module led to increased brittleness.


[Heat expansion of composite resins stored in water].

Thermal expansion coefficients between 10 C and 60 C were determined in 10 degree increments with 10 plastic filling materials and two plastics used for protheses (3 specimens each). The coefficients became larger as the temperature increased. The composites with 20 to 60.10(-6)/C are closest to the thermal expansion coefficient of the tooth; unfilled plastics with 80 to 130.10(-6)/C, the farthest removed. Plastics containing less anorganic filling material demonstrated thermal expansion coefficients between 70 and 90.10(-6)/C. Water absorption did not appear to influence the expansion.


[Water retention and solubility of composite resins dependent on the mixing ratio or the irradiation time].

The deviations in the mixture ratio of 8 paste-paste-systems and 1 powder-fluid system with 50% and 100% each of both components were studied. The quality was examined in relation to the irradiation time with 7 photopolymer cured filling materials. The chemically initiated polymerization of filling material was altered so little by deviations in the mixture ratio that there was no general increase in water absorption. Six of the 9 cured filling materials however showed a significant increase in solubility. The 6 photopolymer cured filling materials tempered with ultraviolet light, in the area examined, showed no obvious alterations in water absorption; all others however with the shorter irradiation periods demonstrated a significant increase in solubility. Tempering of resin polymerized with light required disproportionately long irradiation periods. Water absorption and solubility were accordingly high for the short irradiation periods. The differences between the various materials are more striking than are the differences due to variations in processing.


[Correct timing of work on a hard plaster of Paris model].

Of the individuals in Hamburg questioned, 48% waited an average of 1 to 2 hours after making a stone cast before proceeding with work on it; 38%, 1 day; and only 2%, more than 1 day. The material test however showed that 5 or 6 days of storage at room temperature are necessary before optimal values are obtained for compressive strength, ball-thrust hardness, and abrasive hardness. The greatest amount of expansion with type IV stone plaster, removed from the cast after 30 minutes, was measured between 8 and 24 hours at room temperature, after the plaster had been mixed. The least changes in dimension were recorded after a 5-day contractive phase. Given these results, the stone cast should be stored for 5 to 6 days at room temperature before work is resumed on it if precision work is to be done.


[Prosthetic rehabilitation after loss of the tongue].

By fitting defect prosthesis, the act of swallowing, normalization of speech, and improvement in mastication were restored in many patients with tongue loss. The defect prosthesis also served to increase the volume and mobility of the tongue.


[Postoperative treatment of a patient with a trachea crushed by an accidental injury].

Postoperative treatment of a patient with a crushed trachea due to accidental trauma was reported. The use of an endoprosthesis as an aid for breathing and speaking was described.


[Measures for the testing of the adhesiveness of plastic sealers to dental enamel surfaces].

The adhesiveness of plastic sealers have only been studied in face-ground enamel specimens. A procedure for examining adhesiveness in naturally formed enamel surfaces is described. After treatment with varying concentrations of phosphoric acid, three naturally formed occlusal surfaces were sealed with Enamite, Nuva-Seal, and Alpha-Seal. The best adhesiveness was obtained after conditioning with 50% H3PO4, without additives. The best values were achieved with Nuva-Seal; the worst, with Enamite. Additives to the cauterizing agent distinctly reduced adhesiveness.


[Genetic characteristics and genome structure of Streptomyces coelicolor actinophages].

Actinophage phi C31 of Streptomyces coelicolor A3 (2) and two novel temperate actinophages phi C43 and phi C62 isolated from strains of blue actinomycetes group are homoimmune, serologically and functionally related. DNA molecules of phages phi C31, phi C43 and phi C62 have cohesive ends; sizes of DNAs of these phages and some mutants have been determined. The extent of homology between the DNAs of three phages is 93-96% as shown by heteroduplex analysis. The regions of non-homology are of a deletion-insertion type and of approximately 1500 base pairs in the length. Location of deletions in DNAs of mutant phages phi C31 vd and phi C31 c5 has been shown. Structural modifications in phage dnas have been found only to occur in the right part of molecules. Heteroduplex maps have been constructed for all phages studied.


Cytogenetic studies in an acute leukemia patient following cerebellar astrocytoma.

Acute, monomyelogenous leukemia (AMML) was diagnosed in a patient with a derived 13;14 translocation and prior treatment for a cerebellar astrocytoma. A bone marrow aspirate at the time of diagnosis of leukemia showed abnormalities of chromosome 11, 12 and 16 in addition to the constitutional aberration. The patient's mother carried the same 13;14 translocation, as did 2 siblings, a maternal uncle, and four of his six children. The father had a reciprocal translocation between numbers 1 and 19 which was incidental to the present study.


Different phenotypes of the group-specific component (Gc) in chimpanzees.

The group-specific component (Gc) was examined in a sample of 78 chimpanzees (Pan troglodytes). With isoelectric focusing followed by immunofixation, two different phenotypes are observed. They both differ from the Gc types observed in man. Two alleles are postulated, one coding for a double-band component, the other coding for a single-band component. Neuraminidase experiments indicate the presence of sialic acid in the anodal component of the double-band pattern.


Sister chromatid exchange in lymphocytes from patients with acute lymphoblastic leukemia.

Sister chromatid exchange (SCE) frequencies were studied in peripheral lymphocytes from 16 patients with newly diagnosed acute lymphoblastic leukemia (ALL) prior to the initiation of chemotherapy. The mean SCE frequency (mean +/- SE) for these patients was 12.2 +/- 0.2 per metaphase, which was significantly higher (P less than 0.001) than the mean SCE score for 14 age-matched controls, 7.6 +/- 0.2. Five of these patients were studied again while they were receiving maintenance therapy consisting primarily of daily 6-mercaptopurine and weekly methotrexate. Their remission SCE levels remained significantly higher than controls (P less than 0.005). In addition, SCE levels were studied in 7 long-term survivors of ALL. Three of these patients had been receiving continuous maintenance therapy for at least 3 years. Their mean SCE scores were significantly greater than controls (P less than 0.005). The other 4 patients had finished their final course of chemotherapy at least 8 months prior to the time of sampling, and their mean SCE scores were not significantly different from controls (P greater than 0.10). These data indicate that untreated patients with ALL have increased SCE levels which remain elevated during periods of remission maintained with chemotherapy. However, long-term survivors of ALL who are in remission and off chemotherapy do not demonstrate significantly increased SCE frequencies.


Anatomical and physiological considerations regarding the temporomandibular joint.

The structure and function of the human temporomandibular joint has concerned several investigators but still fundamental questions exist and require further examination. A profound knowledge of the normal anatomy and histology of the temporomandibular joint is necessary to understand its function and functional disturbances. It is also necessary for a good understanding of clinical findings and the interpretation of radiographs. In this paper a clinically orientated description has been given of the anatomy and histology of the mandibular head, the articular fossa and eminence, the articular disc, the capsule and ligaments, the synovial membrane, the innervation of the joint and the normal relationship between the different components. About the physiology of the temporomandibular joint many controversial theories exist. A lot of research has still to be done, especially in the field of the co-ordination of the function of both joints, the muscles and the dentition.


Diseases of the temporomandibular joint.

Cases of myoarthropathy are much more frequent than has so far been assumed. They appear so often that a specific exploratory procedure should form part of the case history and investigation of findings of the dental examination. The result of this examination decides whether diagnosis should be extended by instrumental analysis and whether treatment has to be carried out.


Results of a clinicopsychological study of diseases of the temporomandibular joint.

Patients' complaints relating to disorders of the temporomandibular joint appear to be becoming more frequent and to be occurring in younger age groups. In many cases no organic cause affecting the joint or the masticatory system can be identified as the sole cause of the symptoms. An investigation was therefore undertaken to determine whether psychological causes might also be implicated. Two questionnaires were used to establish a complete picture of patients from a number of countries who suffered from disorders of the temporomandibular joint. The first questionnaire sought particulars of the dental condition, family status, type of education, satisfaction with job and pay etc. The second was a personality questionnaire which had originally been prepared for the Olympic Games in Munich. Although the extensive data collected has not yet been fully evaluated it is clear that in addition to the well established dental causes such as shortened dental arches, deep overbite and cuspal interferences, a psychosomatic element is superimposed in many cases. It is hoped to develop a means by which those whose symptoms require a psychotherapeutic approach, either alone or in conjunction with dental treatment, can be identified.


Surgical treatment of temporomandibular joint ankylosis.

The patient must be made to understand that a normal joint cannot be constructed by any surgical procedure and his part in the rehabilitation programme must be specifically stressed and assurance must be obtained from him that he is willing to carry out instructions during the postoperative treatment. The surgeon must be self disciplined enough to demand the best of himself in any situation and never to be satisfied with less. The surgeon must be generally optimistic, but his knowledge of the local anatomy and the surgical pathology must constantly remind him of his limitations. He must know that we cannot construct a normal joint and we must not promise one.


The dental technician and the attitude of dentists towards his role in Japan.

Historically the development of the Japanese dental care delivery system necessitated the enaction of the Dental Laboratory Technique Law. The Health Insurance Scheme, at present, is not able to operate without the collaboration of dental laboratory technicians. This means that the dental technician may introduce a possible competitive inter-relationship with the dentist who relies on prosthetic dentistry as the major source of his income. It does not mean illegal practice by dental technicians which has so far been negligible. The occupation of the dental technician, therefore, would seem to be very stable. Results obtained during the International Collaborative Study of the Dental Manpower Systems, however, showed some psychological conflict amongst the responding dental technicians.


The Biblical and Talmudic secret for choosing one's baby's sex.

The Biblical verse "If a woman emits semen and bears a manchild" (Leviticus 12:2) is interpreted by the Talmudic Sages and more recent Jewish sources to mean that if a woman emits her "semen" first, she will bear a male child but if the man emits his semen first, she will bear a female child. The Sages of the Talmud thus claimed to have known the secret of determining one's baby's sex. However, whether "emitting one's semen first" refers to orgasm, ovulation, both or neither, is not clear.


Developmental program of murine erythroleukemia cells. Effect of the inhibition of protein synthesis.

The relationship between protein synthesis and commitment to terminal erythroid differentiation by dimethylsulfoxide-treated murine erythroleukemia (MEL) cells has been studied. Treatment with cycloheximide blocks the commitment of MEL cells. The effects of cycloheximide are completely reversible, however. Treatment of MEL cells before commitment delays commitment for a period of time equal to the length of inhibitor treatment. Puromycin exerts a similar effect on the commitment of MEL cells. These results indicate that there is a continuous requirement for protein synthesis before the commitment event.


Identification of Candida lusitaniae as an opportunistic yeast in humans.

Four yeast strains, causally associated with infection in a patient with acute myelogenous leukemia, were identified by standard methods currently used in yeast taxonomy as representatives of Candida lusitania van Uden et do Carmo-Sousa. Because this species has not been recognized previously as an opportunistic yeast in humans, molecular taxonomic methods were applied to confirm its identity. The nuclear deoxyribonucleic acid (DNA) base composition of two clinical isolates was shown to be 45.1 mol% guanine plus cytosine as compared to 44.7 mol% guanine plus cytosine for the type strain of this species. DNA/DNA reassociation experiments revealed more than 95% complementarity between the DNAs from the clinical isolates and that of the type strain of C. lusitaniae, thus confirming their classification by conventional taxonomy. A key is provided to differentiate C. lusitaniae from two phenotypically similar Candida species.


Membrane-bound redox proteins of the murine Friend virus-induced erythroleukemia cell.

We have obtained and studied a 105,000-g pellet from T-3-Cl-2 cells, a cloned line of Friend virus-induced erythroleukemia cells. By difference spectrophotometry, the pellet was shown to contain cytochrome b5 and cytochrome P-450, hemeproteins that have been shown to participate in electron-transport reactions of endoplasmic reticulum and other membranous fractions of various tissues. The pellet also possesses NADH-cytochrome c reductase activity which is inhibited by anti-cytochrome b5 gamma-globulin, indicating the presence of cytochrome b5 reductase. This is the first demonstration of membrane-bound forms of these redox proteins in erythroid cells. Dimethyl sulfoxide-treated T-3-Cl-2 cells were also shown to possess membrane-bound cytochrome b5 and NADH-cytochrome c reductase activity. We failed to detect soluble cytochrome b5 in the 105,000-g supernatant fraction from homogenates of untreated or dimethyl sulfoxide-treated T-3-Cl-2 cells. In contrast, erythrocytes obtained from mouse blood were shown to possess soluble cytochrome b5 but no membrane-bound form of this protein. These findings are supportive of our hypothesis that soluble cytochrome b5 of erythrocytes is derived from endoplasmic reticulum or some other membrane structure of immature erythroid cells during cell maturation.


The extent of the odontoblast process in human dentin.

Impacted human third molar teeth were examined, both with the light and electron microscope, to determine the extent of the odontoblast process. The odontoblast process was found to be limited to the inner third of coronal dentin and inner half of mid-root dentin.


Child-rearing variables affecting the preschool child's response to dental stress.

Responses to dental stress were evaluated in 26 pre-school children during an initial examination visit. Child-rearing practices, assessed by home observation and parental report, were correlated with the dental stress measures. Significant relationships emerged which suggest that child-rearing practices influence the child's acquisition of coping skills and stress tolerance.


Personality factors affecting the preschool child's response to dental stress.

Responses to dental stress were evaluated in 26 preschool children during an initial examination visit. Measures of the children's developmental status and personality were collected during a home visit. Significant relationships emerged which suggest that personality development influences children's ability to tolerate dental stress.


Factors influencing capacity to judge direction of tactile stimulus movement on the face.

The influence of stimulus velocity and traverse length on a subject's ability to indicate direction of brush movement across perioral skin was determined using a forced-choice procedure. The data show that correct identification of brush direction increases with traverse length and is optimal for velocities between 3 and 25 cm/sec.


Plasma and developing enamel fluoride concentrations during chronic acid-base disturbances.

Mild acid-base disturbances were induced in rats for 30 days. These disturbances did not affect % ash of maxillary incisors or % P of the developing enamel from mandibular incisors. Total fluoride intake (food and water) among groups drinking fluoride-free water was constant. Nevertheless, average plasma and developing enamel fluroide concentrations were highest in the acidotic group and lowest in the alkalotic group. Among groups drinking water containing 50 ppm fluoride, total fluoride intake was highest by the alkalotic group and lowest by the acidotic group. Plasma and enamel fluoride concentrations, however, were highest in the acidotic group. It is concluded that plasma and developing enamel fluoride levels can be independent of, or inversely related to, fluoride intake.


Modification by salivary pellicles of in vitro enamel remineralization.

The effectiveness of inorganic calcifying solutions to remineralize enamel with subsurface demineralization decreased with saliva pre-treatments conducive to the formation of enamel pellicles. Greater reductions in remineralization rates occurred with longer pellicle formation times. It is suggested that enamel pellicles may act to control surface deposition and favor subsurface precipitation.


Effects of pin hole position on stress distributions and interpulpal temperatures in horizontal nonparallel pin restorations.

Biomechanical evaluation was made of horizontal nonparallel pin position effects on stresses of tooth structure and interpulpal temperatures with a stress analysis and heat conductive analysis, following finite element methods. The results were that it is adequate to use geometry to decide horizontal pin position in a routine clinic.


The failure of self-threading retentive pins under tensile load.

The resistance of self-threading retentive pins to failure in tension is due primarily to residual compressive forces in dentin generated during pin insertion. Examination of load-elongation curves and photomicrographs of samples also indicated that the interlocking of pin threads with dentin provides only a minor contribution to the peak retentive load.


Clinical performance of a gold-containing amalgam.

In this study, the clinical performance (marginal fracture) of a gold-containing amalgam was compared to five traditional gamma 2-containing amalgams and one non-gamma 2 amalgam. The results showed that the performance of this gold-containing amalgam was bettered by the non-gamma 2 amalgam and four of the five gamma 2-containing amalgams. A microprobe evaluation of a five-year-old clinical restoration made from this alloy revealed an unusual corrosion pattern.


In vitro wear of microfilled and visible light-cured composites.

Wear of microfilled composites, a visible light-cured composite, and a conventional composite were characterized by two-body abrasion and single-pass sliding. There were differences in abrasion rates among the materials. Tangential forces, wear track widths, and surface failure modes were different among materials. Wear characteristics are combinations of these properties.


Exposure time and the effect of hexylresorcinol on bacterial aggregates.

The bactericidal effect of hexylresorcinol was assessed using bacterial aggregates. Increased drug concentration resulted in decreased survival of bacteria when the aggregates were exposed to hexylresorcinol for at least eight hours. This indicates that this drug may be effective against dental plaque only when available for long periods of time.


Relationship between structure and the stress pattern in the human mandible.

The internal bony structure of ten dentate human mandibles was examined on lateral radiograms, and the condylar shape measured with a digital electronic machine. The external surface was coated with photoelastic material. Each mandible was then placed in centric occlusion with brass replicas of the upper arch and the glenoid fossae and set in a supporting frame. Occlusal loads were simulated and the isoclinics recorded in plane-polarized light. The isostatic flow lines were constructed for each mandible. A relation was found between the mandibular structure and the distribution pattern of these lines.


A further assessment of predictors of the child's behavior in dental treatment.

The child's disruptiveness during dental treatment was related modestly to his age as well as his state, trait, and dental anxiety. In three samples comprising 132 experienced and 49 inexperienced pedodontic patients, the child's behavior during treatment could not be predicted from any aspect of maternal anxiety -- trait, state, or dental. Previous conceptions of maternal influence on the child's dental anxiety should be re-evaluated.


Comparison of the plaque microflora in immunodeficient and immunocompetent dental patients.

The nature and extent of the immune dysfunctions in 20 immunodeficient patients, as well as the immunocompetence of 22 control subjects, were verified by cell-mediated responsiveness and immunoglobulin quantitations. Comparisons of the microbial composition of supragingival plaque between the two populations showed that a greater number of immunodeficient than control subjects harbored Candida sp. and Staphylococcus sp. Conversely, a lower number of immunodeficient than control subjects harbored Streptococcus mutans. Also, patients with immune dysfunctions had a lower dental caries experience than their immunocompetent counterparts.


EMG silent periods in immediate complete denture patients: a longitudinal study.

Jaw muscle silent periods in response to chin taps were recorded from immediate complete denture patients before extraction of a residual anterior dentition, after insertion of the dentures, and three and six months after insertion. After three months' use of the dentures, the mean EMG silent period duration was significantly increased compared to the pre-extraction stage.


The crystalline components of dental calculi: human vs. dog.

Dental calculus from the dog was found to consist principally of the calcite form of calcium carbonate mixed with small amounts of apatite; other calcium phosphates, consistently present in human calculus, were not present in dog calculus. Precipitable calcium salts from human saliva were mainly apatite; for the dog the principal precipitated salt was calcium carbonate (calcite form).


Design of studies to evaluate plaque control agents.

The importance of plaque in the etiology of periodontal diseases is reviewed. A survey is also presented of the various indices for scoring plaque in clinical trials. Variations in the clinical design, type of population studied, and difficulty in scoring gingival plaque are reviewed. A survey is presented of some recent published studies of plaque-inhibiting agents.


In vitro testing of plaque control agents.

The development of a number of in vitro techniques for the evaluation of antiplaque effects of test agents has followed the characterization and culturing of plaque-forming microorganisms. Studies of the mechanism of action of chlorhexidine and clinical observations have assisted in defining critical aspects of these in vitro techniques. Such assays may play an increasingly important role in screening potential new agents as well as in the optimization of properties by chemical modification of new lead agents. In addition, data generated in the in vitro assay may assist the design of in vivo evaluations of new agents. Proper selection of in vitro techniques for these various functions in the pre-clinical development process may reduce the time and cost involved in the development of new antiplaque agents.


Do dental students cheat?

In a questionnaire survey, dental students from all four classes at The University of Iowa College of Dentistry were asked if they had cheated during their first and second years. They were then asked if they believed that others cheated. Cheating was admitted to by 43 percent of the respondents, but 94 percent believed it was occurring. Plagiarism was delineated as a form of cheating; while fewer students admitted to its use, the reported occurrence should be of concern in technique courses. Responses were analyzed both by year in school and grade point average. Reasons for cheating were described; and some conditions conducive to cheating were found to be under the control of the instructor.


Survey research and the silent majority.

A survey conducted at the New York University Dental Center demonstrated that significant differences exist between patients who are ready participants in research efforts and those who require the more persistent attention of the researcher. In addition, patients who were questioned while in treatment emphasized different reasons for selecting a dental school for treatment than did those patients who were interviewed prior to beginning treatment. The importance of collecting data from a truly random sample of patients is stressed and elaborated with reference to the marketing implications of the results. Strategies for patient recruitment and retention require knowledge that is complete and does not suffer from systematic absences in the data base. Careful data collection methods are described and advocated.


The undergraduate dental radiology curriculum.

This paper reviews and analyzes the undergraduate dental radiology curriculum as suggested by the American Academy of Dental Radiology and the Oral Radiology Section of the American Association of Dental Schools. In addition, pertinent findings of the 1976 curriculum study conducted by the American Dental Association are discussed.


A course in physical, clinical, and laboratory diagnosis for dental education.

A basic knowledge of physical diagnosis techniques and an understanding of those parts of clinical medicine (including laboratory diagnosis) most closely related to dentistry are recognized to be important parts of dental education. The course in physical, clinical, and laboratory diagnosis for dentists pursuing specialty training in oral surgery, endodontics, periodontics, oral diagnosis, prosthodontics, and general practice at The University of Michigan School of Dentistry is described.


An auxiliary evaluation of dental student management style.

An instrument has been developed to identify a dental student's leadership style. This instrument is used in the TEAM program at the University of Louisville as an aid in teaching dental students basic personnel management principles.


Is radiographic examination a reliable method of detecting caries under old restorations?

As a result of our survey, we have reservations about the reliability of radiographic examination for detection of caries under old restorations. Except in rare cases, all old restorative material should be removed and replaced before the construction of a cast crown restoration.


Nocturnal electromyographic evaluation of myofascial pain dysfunction in patients undergoing occlusal splint therapy.

Twenty-five patients with symptoms of myofascial pain and abnormal jaw function were treated with use of a full arch maxillary occlusal splint. The level of nocturnal activity of the masseter muscle was monitored as were symptoms before, during, and after occlusal splint therapy. A decreased nocturnal EMG level during treatment was noted for 52% of the patients. A return to pretreatment EMG levels after removal of the splint was noticed in 92% of the patients; in 28% no change was shown and in 20%, an increase was shown in nocturnal EMG levels. The splint was most likely to reduce nocturnal EMG levels in patients with least severe symptoms.


The relationship between nitrous oxide conscious sedation and the hypnotic state.

To evaluate the hypothesis that inhalation of low levels of nitrous oxide-oxygen produces an altered state of consciousness similar to hypnosis, 20 subjects were given three suggestions (analgesia, compulsive behavior, and amnesia) during double-blind administration of either nitrous oxide-oxygen or oxygen. Results suggest that administration of nitrous oxide-oxygen may be of increased clinical usefulness if it is combined with careful use of suggestion.


Developmental variations of tooth morphology and periodontal disease.

Some developmental variations of tooth morphology may influence the potential for periodontal disease by allowing accumulation of bacterial plaque and calcified deposits. Mechanical plaque control becomes difficult even for the conscientious patient. Periodontal disease may be hastened in these cases. The therapist must be aware of these variations and their significance in the etiology of isolated periodontal lesions. Recognition of these anomalies and early diagnosis may improve the prognosis of the involved tooth.


Properties of  microfilled and visible light-cured composite resins.

Physical and mechanical properties of four commercial micro-filled composite resins, a visible light-cured composite resin, and a conventional composite resin were investigated. Isocap, Isopast, and Superfil were similar in most properties. Compared with Concise, they had lower values of inorganic filler content and modulus of elasticity and higher values of water sorption, depth of indentation, and linear coefficient of thermal expansion. The properties of Silar were between those of Concise and the other microfilled composite resins. Fotofil had lower values of modulus of elasticity, water sorption, and linear coefficient of thermal expansion than Concise.


Dentigerous  cyst with mural ameloblastoma.

A case of a 14-year-old black girl with a lesion that appeared to be a dentigerous cyst is presented. Radiographic appearance, findings of a bone scan and biopsy by aspiration are discussed. Histologic findings showed that the lesion was an ameloblastoma that is believed to have arisen from the dentigerous cyst wall.


Amelogenesis imperfecta: local hypoplastic type with pulpal calcification.

A case report of a patient with local hypoplastic type of amelogenesis imperfecta is presented. Developmentally absent canines and unerupted teeth in the anterior maxilla and calcifications in the apical third of the pulp chambers of the molars were noticed and discussed. A family history was analyzed as consistent with an autosomal dominant form of transmission of the disorder.


Iron deficiency: an overlooked predisposing factor in angular cheilitis.

Clinicians who recommend the use of antifungal agents for angular cheilitis may be treating the symptoms and not the predisposing cause of the disease. Iron deficiency should be considered as part of the differential diagnosis whenever angular cheilitis is encountered, especially in women of child-bearing age.


Facilitating oral hygiene in patients with chronic schizophrenia.

Ten patients with chronic schizophrenia and with poor maintenance of dental hygiene were instructed, using a variety of motivational and reinforcement techniques, to improve oral hygiene. Results indicated significant changes in several of the most maladaptive behaviors.


Side effects of long-term treatment with human leukocyte interferon.

Twenty-nine patients, 27 of them with osteosarcoma and two with juvenile laryngeal papilloma, were followed for an aggregate period of 365 months, during which time they received long-term treatment with human leukocyte interferon. The interferon was given by intramuscular injection either daily or three times a week; the dose was 3 x 10(6) standard units. During the course of the treatment, 12 distinct symptoms were recognized as possible side effects of the drug; the three most frequent symptoms occurring after injection were fever, local pain, and shivering. All but three of the patients reported between one and five symptoms. Partial purification of the interferon reduced or eliminated some, but not all, of the symptoms. All of the patients were treated on an ambulatory basis, and none had to discontinue the interferon therapy because of the side effects.


Selective angiographic studies prior to Le Fort I osteotomy in patients with cleft lip and palate.

In 12 adult patients with cleft lip and palate, external carotid arteriograms were performed. The arterial blood supply to the maxilla, before forward movement by Le Fort I osteotomy was demonstrated. In 14 instances the descending palatine artery and its branches were found to be free from pathological changes. In 10 instances the calibre of the palatine artery was considerably diminished. Clinical experience shows, that after multiple operations for cleft palate, osteotomy of the maxilla with forward movement, can cause circulatory disturbance in the mobilized segments. Such complications can be avoided by the proper choice of procedure. The selective carotid angiogram demonstrates the arterial blood supply to the maxilla and aids in planning correction of the hypoplastic mid-face.


A follow-up of osteotomies for dysgnathia.

An invitation to report for a follow-up was accepted by 74 patients (51 females and 23 males) who had undergone various types of osteotomy (50 mandibular and 30 maxillary osteotomies; 6 patients had undergone both mandibular and maxillary osteotomy). Their age at the time of operation ranged from 15 to 44 years. The follow-up period ranged from 3 months to 7 years. Maxillary osteotomy was never followed by a relapse, but 12 of the 50 patients treated by mandibular osteotomy showed some relapse: hyperplasia of the mandibular condylar process caused some relapse in 2 cases, and in 10 other cases only partial relapse (1, 2 or 3 mm) occurred. The distribution over the various types of operation corresponded with the various methods used in the entire series, so that no particular type of operation had evident advantages or disadvantages. It is essential that stable occlusion is achieved during the operation. Osteosynthesis of the fracture fragments proved unnecessary after a sagittal split operation. No indications that an oversize tongue played a role were found. The results with regard to the temporomandibular joint were particularly favorable. Stable occlusion is essential in preventing relapse; this is one of the reasons why a careful long-term follow-up is indicated (at 2-year intervals). For the time being this is perhaps best carried out by the operating surgeon, who has previous models and knows the patient.


Follow-up investigation of surgical correction of the atrophic alveolar ridge by visor-osteotomy.

In 1975, a method of operation was described whereby the alveolar ridge of the mandible is osteotomied and moved on the visor principle. The two parts are fixed together with wires, thereby increasing the absolute height of the mandibular alveolar ridge. The visor-osteotomy in conjunction with vestibuloplasty and lowering of the floor of the mouth, significantly improves the denture bearing area, without the need for, and risk incurred by free bone transplantation. During the course of prosthetic treatment, one should bear in mind that there will be a temporary disturbance of sensation of the mucosa. Check-ups should be frequent. The post-operative results after three years were recorded in ten patients. There was 18% resorption of the augmented alveolar ridge over the first year. In the second year 10% and in the third year 8% or 0.6 mm. The same amount of mandibular resorption occurs following a simple, total vestibuloplasty. Three years after a visor mandibular ridge augmentation, the mandible shows physiological resorption.


Cancrum oris.

Cancrum oris is a gangrenous infection of the oral cavity. Debilitating diseases predispose to the condition. The exact bacteriology is uncertain although Vincent's Spirochaete and the fusiform bacillus in symbiosis have been considered to be the actual cause of the condition. The presentation of the disease is variable, for the condition may affect the soft tissues of the face or the bones of the facial skeleton or both concurrently. This disease has a high mortality rate. If recovery from toxaemia ensues, subsequent healing becomes a lengthy affair because of the destructive nature of the condition. Since the introduction of antibiotics as a form of therapy, a higher survival rate has been achieved. Because of the nature of the condition the morbidity rate is exceptionally high with functional disturbances and disfigurement being a legacy of the disease. Reconstructive procedures are generally required at some subsequent stage.


Multiple basal cell carcinomas and keratocysts - the Gorlin and Goltz syndrome.

This paper is based on our experience with the Gorlin-Goltz syndrome and on data from 14 patients of the Nordwestdeutsche Kieferklinik in whom this disorder was detected, treated and followed up. A clinical concept has been produced, with a diagnostic check list including a genetic and a dermatological routine work up as well as a radiological survey of the jaws and skeleton. Whenever multiple basal cell carcinomas plus the typical jaw lesions are found in a patient, the diagnosis is easy. A minimum diagnostic criterion is the combination of either the skin tumours or multiple odontogenic keratocysts plus a positive family history for this disorder, bifid ribs, lamellar calcification of the falx cerebri or any one of the skeletal abnormalities typical of this syndrome. All those in whom this disorder is diagnosed or suspected should be followed up for the rest of their lives. The family should be examined and genetic counselling should be offered.


Views on the relative indications for suprahyoid and radical neck dissections.

The various operative possibilities for the treatment of the lymphatic drainage area in the presence of a malignant epithelial tumor of the maxillofacial region are compared with one another and in particular the indications for surgery are examined in connection with the TNM classification.


Hoigné's syndrome-its course and symptomatology.

The study presents the clinical symptomatology of acute embolic-toxic reactions to penicillin seen in 9 patients treated with the drug. The complex of short-lasting symptoms characterized by severe agitation with confusion, visual and auditory hallucinations and dire fear is caused by accidental penetration of an amount of intramuscular penicillin injected into the venous system. The authors' experience and the data so far published reveal a much more frequent occurrence of Hoigné's (1959) syndrome than is usually thought. The syndrome does not depend upon the dose of a single injection of procaine penicillin but it may be attributed to poor technique of intramuscular injection and to great number of injections in a small area of the buttock. It is recommended that intravenous steroids in the treatment of acute symptoms of Hoigné's syndrome beside pharmacological sedation of the patient are applied.