[Gingivectomies. Flap operations (author's transl)].

Peridontal surgery is only one of a series of treatments for peridontopathies. It is always dependent on buccal hygiene. Gingivectomies and especially flap operations, are one kind of therapeutic solution but not the only one; these are very efficient means to handle the clinical problems. The techniques (listed in the report) must be adapted to each particular circumstance (kind of bone and muco-gingival lesion, etiological factors, stage of disease) and when these techniques are used in their various ways for precise indications they will give the best results.


[Muco-gingival procedures (author's transl)].

The gingival marginal region, in which the inflammatory processes of parodontal disease commence, needs to be protected by a sufficient height and thickness of attached gum. Surgical procedures for these lesions must, therefore, involve the attached gum. A variety of muco-gingival procedures have recently replaced the classical vestibular deepening operation which was always followed by a relapse.


[Facial artery injury from a bullet wound discovered after arteriography (author's transl)].

Signs of a fracture of the mandible and a submaxillary hematoma were present in a patient wounded by a bullet. Selective carotid arteriography by femoral catheterization revealed the presence of sectioning of the facial artery at its origin and underlying external carotid stenosis. Hemorrhagic complications or aneurysm formation could have occurred if the lesion had not been demonstrated. Though arteriography is not without risks, it is irreplaceable for investigating cervicofacial injuries when a vascular lesion is suspected.


[Uranostaphytopharyngoplasty using an inferior pedicle (author's transl)].

Treatment of deficiencies of the soft palate is dependent upon its condition, and the plastic surgeon is guided in his therapy by its length and suppleness. This was also the case when, in the past, a prosthesis had to be applied. If it is sufficiently long and supple a simple velopharyngoplasty, followed by phonetic reeducation, has every chance of producing a good result, at least in cooperative children and adolescents. When the soft palate is very shortened, however, a simple velopharyngoplasty does not ensure effective rhinopharyngeal occlusion and lengthening of the soft palate and the palatine mucofibrous tissue must be performed at the same time by means of a uranostaphylopharyngoplasty. In practice, this latter procedure is preferable in the majority of cases. We have used either superior or inferior flaps but over the last 25 years we have preferred the latter type of flap (Rosenthal) which produces better results because: 1) it is retracted laterally to a lesser degree, 2) it is more supple, 3) it is attached below and posteriorly to the soft palate (which permits the pharyngeal constrictor muscles, during contraction, to apply pressure against the lateral borders of the flap, and thus avoid any nasal regurgitation).


[The value of surgery in parodontal treatment (author's transl)].

Treatment of parodontal affections must include all therapeutic procedures available. Surgical treatment, which aims at suppressing the parodontal lesions and creating an architecture which avoids relapses, is still the principal weapon. As, however, in the last analysis, the causes of parodontal lesions are infection and constraint, occlusive treatment is an extremely important part of therapy, integrating occlusal equilibration, orthodontal procedures, and the prosthesis.


Cell proliferation and DNA dependent DNA polymerase estimation in acute lymphoblastic leukaemia during treatment with prednisone and vincristine.

The presence of DNA polymerase and primer-template DNA in lymphoblast nuclei by measuring the in vitro incorporation of 3H-thymidine-5'-triphosphate (3H-TTP) was studied in 10 patients with acute lymphoblastic leukemia. Protein synthesis and various other cytokinetic parameters were also studied. After prednisone (P) administration a marked decrease in 3H-TTP labelling index (3H-TTP LI) was apparent together with an inhibition of 3H-leucine incorporation (3H-LEU LI) into lymphoblasts. A moderate decrease in 3H-TDR labelling index (3H-TDR LI) and a later decrease in mitotic index (MI) were seen. Single cell DNA measurements showed a depletion of 3H-TDR labelled lymphoblasts in early part of S-phase apparent at 24 h lasting up to 54 h after P administration. Vncristine given as a flash injection later in the study period caused an immediate rise of the MI, at the same time the P induced decline in 3H-TTP LI, 3H-TDR LI and 3H-LEU LI were continued in most patients. P is thought to damage the cells both in and outside the cell cycle. In the cell cycle the effect of P is an arresting effect in G1.


Role of tears in maintaining corneal integrity.

In addition to providing a smooth optical surface, the tear film moistens and protects the cornea by providing a wide variety of antimicrobial substances. Accessory secretions of the conjunctiva and tarsal glands play an important protective role in lubricating, promiting wetting of the corneal epithelium by tears, stabilizing the extremely thin precorneal film, and reducing evaporation.


Role of the ocular surface in destructive corneal disease.

Corneal destructive disease is related to the ocular surface in at least three ways. Firstly, the maintenance of surface integrity seems to protect the corneal stroma from ulceration. Such integrity is jeopardized if the corneal epithelial cells fail to replicate themselves, or if they fail to adhere tightly to the underlying stroma. Secondly, the ocular surface plays a role in ulceration. Elaboration of collagenolytic enzymes may occur in the abnormal ocular surface epithelial cells themselves. In addition, the surface may modulate the leucocytic response in the stroma, the leucocytes themselves being responsible for the ulceration of the stroma. Finally, the ocular surface appears to play a role in superficial vascularization of the cornea. When all of the corneal epithelium is lost, as is the case in widespread chemical injury, sluggish metabolic transformation of conjunctival cells is associated with vascularization.


Aspects of corneal wound healing in health and disease.

The paper reviews current aspects of repair processes of the epithelial, stromal, and endothelial layers for both the normal and diseased cornea.


How the cornea defends itself.

The normal cornea is a dense, firm structure through which few inflammatory molecules and micro-orgnaisms are admitted. It usually lacks at least one of the components necessary for immunological reactions. Thus, these reactions are unlikely to be initiated within the cornea. A look at the tissues surrounding the cornea shows that the conjunctiva is rich in inflammatory reactants. Blood and lymphatic vessels (and also the tears) provide important systems that transport immunological elements to the cornea. Thus, the main forces for corneal destruction--and defence--probably come from its surrounding tissues.


Corneal changes due to alkali burns.

Rabbit corneal epithelium and endothelium were destroyed in vivo with 0.5 normal sodium hydroxide applied to the anterior surface of the cornea for 1 minute. Specimens were studied by transmission and scanning electron microscopy. Cellular necrosis is intense during the first day and healing begins on the third day on both surfaces of the cornea. The epithelial side is covered with new cells in 12 days and the eptihelium is normal on the 21st day, but there is a transformation of part of the corneal epithelium by conjunctival epithelium. On the endothelial side, healing is very slow and for this there seems to be two reasons: (1) Persistent cellular necrosis, (2) Inflammatory reaction which disorganizes the regenerating process. The overstimulation caused by this slow cicatrization leads to the formation of a retrocorneal membrane similar to those observed in human pathology.


Systemic immunosuppression in marginal keratolysis.

Experience in the investigation and treatment of eleven patients with the peripheral corneal melting syndrome is described. It is considered that short-term treatment with non-corticosteroid immunosuppressive regimes should be tried in patients with severe progressive disease which may not respond to other methods of treatment.


A pathological study of eye involvement in acute leukemia of childhood.

The eyes of 60 children dying of acute leukemia between 1968 and 1976 at the Children's Hospital Medical Center have been examined pathologically. An attempt has been made to relate eye findings to the state of the systemic disease at the time of death. Eight of the 60 patients had leukemia retinal infiltrates and all eight had fulminant disease with terminal leukocyte counts over 100,000 per cubic millimeter and a high percentage of "blast" cells. Twenty-six patients (43%) had leukemic infiltration of the choroid which was not apparent clinically, but which would require therapy in any effort to eradicate leukemic cells from the body. Five of six patients with optic nervic involvement had coexistant meningeal leukemia. Isolated retinal hemorrhages could not be correlated with other parameters of the leukemic process.


Hematologic abnormalities preceding myeloid leukemia in three cats.

Cytopenia were recognized in three cats infected with feline leukemia virus. In one cat, marrow blast cells were increased in number, and a diagnosis of aleukemic leukemia was made. The disease progressed slowly for 3 1/2 months before terminating in acute myelomonocytic leukemia, recognized as a blast crisis in blood. In the other two cats, neutropenia and altered granulopoiesis in bone marrow preceded development of myeloid leukemia.


[Acute myeloid leukemia during Hodgkin's disease].

A patient with Hodgkin's disease is reported in whom 5 years after establishing of diagnosis acute myeloid leukaemia developed during multistage treatment. The patient died. The authors discuss the problem of leukaemia-inducing influence of intensive radiotherapy and chemotherapy.


Mathematical model of the proliferation cycle of lymphoblastic leukemia cells.

In the paper a system of equations is described, which enables computation of the mean number of leukemic cells in the blood as a function of time. After formulation of the problem in the form of cybernetical model, the equations are derived. Then the results of modeling obtained with the aid of a digital computer are described. The paper concludes with short summary.


Evidence of active transport (filtration?) of plasma proteins across the capillary walls in muscle and subcutis.

Under slight lymphatic stasis (tilting the body 15 degrees) we measured the arrival of locally injected 131I-albumin in the plasma pool. From 30 min to 90 min after the injection the return rate was zero, i.e. local back transport in the two tissues studied, muscle and subcutaneous fat, is very small. Compared with a suggested steady state total 131I-albumin clearance of 1.7%/hour in the horizontal body position, we conclude that a maximum of 1% of the interstitial albumin can have a local transendothelial escape, i.e. can be handled by passive forces, such as diffusion and pinocytosis. Since passive flux is proportional to the concentration, and since the interstitial albumin concentration is about half the plasma concentration, then also diffusion and/or pinocytosis of albumin from the plasma is negligible in the resting normal human. We suggest that filtration through large leaks is the main mechanism for transendothelial protein transport.


Experimental and quantitative analysis of microcirculatory water exchange.

Quantitative and direct studies of microcirculatory fluid exchange phenomena provide evidence that fluid tissue balance in omentum and mesentery is achieved through lymphatic drainage. Fluid exchange in muscle appears to alternate between filtration and absorption from the capillaries in synchrony with arteriolar vasomotion. Detailed calculations show that, in the absence of hydraulic or osmotic pumping at the level of the terminal lymphatics, tissue pressures are of the order of +6 cm H2O for both visceral and muscle tissue. It is concluded that these microcirculatory beds represent two extreme types of mechanisms for achieving fluid balance, and that most other tissues, with the exception of liver and tumors, operate in between.


[Immunological characteristics of lymphocytes during intensive treatment maintaining remission of acute lymphoblastic leukemia in children and following withdrawal from chemotherapy].

In 22 children with lymphoblastic leukaemia peripheral blood lymphocytes were studied during 2.5 years of remission-maintaining treatment, and in 7 cases also after stopping treatment. Lymphocytes T and B were identified and lymphocyte surface receptors for complement and for the Fc fragment of IgF were determined. The immunological reactivity of lymphocytes was determined also using the test of PHA-induced blastic transformation. It was found that prolonged chemotherapy caused depression of lymphocytes B in the first place. A fall was observed also in the proportion of cells undergoing transformation. It was shown that after cessation of treatment PHA-reactivity and normal values of lymphocyte subpopulations returned.


Chronic neutrophilic leukemia. Report of two cases and review of the literature.

Chronic neutrophilic leukemia is a rare, infrequently recognized, myeloproliferative disorder. It usually manifests as a leukemoid reaction, with mostly mature granulocytes in the peripheral blood, with rare to occasional immature forms, and sometimes with normoblasts. The clinical manifestations also include hepatosplenomegaly, elevated leukocytic alkaline phosphatase, elevated serum vitamin B12 and serum vitamin B12 binder ("R" fraction), and elevated serum uric acid. Distinction from a leukemegaly, the absence of sepsis, usually normal erythrocytic sedimentation, and the absence of fever. Leukemoid reactions may be associated with elevated serum vitamin B12 and uric acid, but the levels are usually lower than those found in chronic neutrophilic leukemia. Many patients have gouty symptoms, especially after treatment with Busulfan, and many have an unexplained hemorrhagic tendency, making major operations a risk. The authors add two cases to the 11 previously described.


Acute lymphoblastic leukemia followed by acute granulocytic leukemia in a pediatric patient.

A 14-year-old white male patient had acute lymphoblastic leukemia characterized by a periodic acid-Schiff (PAS)-positive reaction, negative T and B cell markers, and negative nonspecific esterase and peroxidase reactions. Ten months after the initial diagnosis, the bone marrow appearance was compatible with acute granulocytic leukemia, with the presence of Auer rods, and with peroxidase-positive, nonspecific esterase-negative, and negative PAS reactions. Karyotyping and banding were not performed. The concurrence of both diseases in this patient is unique in pediatric oncology.


Chromosome changes in a patient achieving complete remission in the acute phase of chronic myelogenous leukemia.

A patient with chronic myelogenous leukemia (CML) had a Philadelphia chromosome (Ph') [t(9q+;22q-)] in all cells and trisomy C in 13% of cells (later determined to be trisomy 8) at the time of diagnosis. After 21 months of intermittent treatment with busulfan, the acute phase developed with the appearance of an additional abnormality (trisomy ? 19). During a complete remission and reconversion to the chronic phase, trisomies 8 and ? 19 DISAPPEARed, although the Ph' remained. Following a period of marked thrombocytosis, a second relapse occurred with the reappearance of both marker chromosomes.


The concept of pattern in craniofacial growth.

1. There are semantic and associated problems with the word pattern in biology, particularly in orthodontics and facial growth. 2. Pattern, as we use the term, is invariance of relationships--"a set of constraints operating to preserve the integration of parts under varying conditions and through time." 3. Craniofacial pattern can be described and quantified by the identification of craniofacial constants, measures that are relatively invariant. 4. Growth is change and is best identified by studying those measures of size and shape that vary most sensitively through time over development stages. 5. The many traditional cephalometric measures that represent well neither pattern nor growth (mixed) are of less clinical utility than either pure pattern indices or growth indices. 6. The analytical and conceptual separation of pattern and growth seems useful in analysis of morphology, analysis of growth, prediction of growth, and clinical treatment planning.


Treatment of severe mandibular retrusion in class II, division 2 malocclusion.

The case of an adult patient with a severe mandibular retrusion of the Class II, Division 2 malocclusion type has been presented. The patient's marked anteroposterior discrepancy was complicated by the severe malocclusion. The solution to this case involved presurgical orthodontic treatment to allow for surgical mandibular advancement by a modified sagittal osteotomy and postsurgical orthodontic care for alignment of the dentition. A discussion of the importance of the patient's facial growth type for stable mandibular advancement has also been presented.


Cephalometric evaluation of surgical orthodontic treatment for the correction of anterior cross-bites.

Severe skeletal Class III malocclusion cases were treated by surgical orthodontic techniques. Surgical operations included alveolar osteotomy, horizontal osteotomy of the mandibular ramus, osteotomy of the mandibular body, and sagittal-split osteotomy of the mandibular ramus, according to the type of malocclusion. Comparisons between lateral cephalograms made before and after operation at the prognosis examination were made for the four surgical procedures.


The orthodontic center of rotation of the maxillary central incisor.

The cephalometric records of sixty-four Class II, Division 1 cases treated exclusively with removable orthodontic appliances have been used in a study of the manner in which maxillary central incisors tilt. The center of rotation was most frequently located in the middle third of the incisor root. The longer the time interval between the pre- and posttreatment cephalograms, the more apical was the rotation axis likely to be, an effect ascribed to growth changes in the maxilla. If the effects of growth are taken into account, it seems that the maxillary central incisor seldom, if ever, tilts about the apical third of its root when force levels customarily recommended for tipping movements are employed. The results suggest that the instantaneous and orthodontic centers of rotation are one and the same and support the view that the manner in which incisor teeth move in response to a single applied force depends principally on the physical properties of the tooth root, supporting bone, and periodontal membrane. An unexplained correlation was found between the rate of incisor movement measured at the cervical margin of the tooth and the level of the rotation center.


Serum amyloid A to monitor cancer dissemination.

The level of serum amyloid A, a protein previously found to behave as an acute-phase reactant, was measured by a radioimmunoassay in 621 patients with various neoplastic diseases free of inflammatory processes. In all but eight of the 289 patients with solid tumors with distant metastases, in all patients with myelocytic leukemia with high leukocyte counts, and in all patients with advanced lymphoma, the serum amyloid A level was above 400 ng/mL. It was below this value in all tested patients with lymphocytic leukemia and in 250 of 270 patients with solid malignant tumors with localized or regional disease. Among the 20 patients from this latter group with levels higher than 400 ng/mL, 16 developed distant metastases within 214 days from the initial measurement. The serum amyloid A level decreased significantly in patients with lymphoma and those with metastatic solid tumors who responded to chemotherapy. Thus the level of serum amyloid A can be used as a biochemical marker that discriminates between disseminated and localized or regional disease, and monitors the response to therapy.


Histometric and electron cytochemical study of muscle in the dystrophic mouse.

A histometric analysis of the alterations at the motor end plate in dystrophic Bar Harbor mice has been performed. In both forms of mouse dystrophy, simplification and focal atrophy of the junctional folds and retraction of the nerve terminal represented the significant changes. The postsynaptic alterations were similar to those described in Duchenne dystrophy. In constrast, the presence of presynaptic alterations in these mice indicated the presence of both a neural and a muscular abnormality. The wedge-shaped focal lesions in the muscle of dystrophic mice were demonstrated by both in vitro and in vivo HRP tracer techniques. These focal degenerative changes in muscle were similar to those described in Duchenne dystrophy. Employing the technique of extracellular space tracing, a comparison was made of the appearance of the transverse tubular system in the various types of dystrophic muscle fibers.


Therapeutic trials in hamster dystrophy.

Verapamil and prenylamine, which antagonize calcium influx into heart muscle cells, Dibenamine and propanolol, alpha and beta adrenergic bockers, respectively, and prostaglandin E1, which acts on permeability of cell membranes and on adrenergic neurotransmission, were all shown to markedly reduce the severity of heart lesions in UM-X7.1 cardiomyopathic hamsters. The beneficial effects of these compounds seen essentially preventive, in that they do not afford protection for fully developed skeletal muscle lesions. The occurrence of the pathologic changes in the myocardium coincides with an increased adrenergic nerve activity, and it is believed that these drugs function mainly by decreasing calcium conductivity across the sarcolemmal membranes of cardiocytes.


Mechanism of action of penicillamine in the treatment of avian muscular dystrophy.

Penicillamine, a cysteine analog with a reduced sulfhydryl group, has been used in this laboratory for the treatment of hereditary avian dystrophy. The drug delays the onset of symptoms and alleviates the debilitating aspects of the disease. To study the mechanism of drug action, the effects of penicillamine on white and red muscles of dystrophic chickens were examined with regard to the specific activities of the soluble enzymes glyceraldehyde-3-phosphate dehydrogenase, acetylphosphatase, glucose-6-phosphate dehydrogenase, 6-phosphogluconate dehydrogenase, glutathione reductase, glutathione preoxidase, superoxide dismutase, and catalase. The sulfhydryl contents of the soluble proteins and the concentration of myoglobin were also determined. In white dystrophic muscle (pectoral), there were large alterations in the various enzymatic activities compared to normal levels. In the DISCUSSION, these changes are related to the pathogenesis of the disease and to the adaptive response for protection of the severely affected fast fibers. Red dystrophic muscles (thigh) were minimally involved, in accordance with the known sparing action of the slow fiber type. The results suggested that the disease process in dystrophic muscle may be due to oxidation of the essential sulfhydryl groups of proteins. Penicillamine may produce therapeutic effects by altering the intracellular redox status, thereby promoting better regulation of enzymatic activity, membrane stability, and improved muscle function.


Penicillamine in the therapy of hereditary muscular dystrophy in chickens.

This was a brief 6-month study of the possible value of penicillamine in adult chickens with hereditary muscular dystrophy. Detailed histologic investigation of various parameters of muscle architecture yielded no evidence of significant therapeutic effect. Several serious toxic symptoms were noted. It is suggested that in muscular dystrophy, a disease in which the main feature is profound alteration of muscle structure, histologic studies may be the best means of documenting response to therapeutic agents.


Cardiomyopathy of hamster dystrophy.

Investigations of the fine structural changes observed in the hearts of cardiomyopathic hamsters at very early stages of the disease indicate that the initial changes involve the pericapillary mesenchymal cells. Other prominent features consist of hypercontraction of cardiocytes, disruption of intercalated disks, and eventual partitioning of cardiac cells, with myofibrillar lysis. The generalized plasma membrane defect allows a net increase in calcium influx and a depression in mitochondrial respiratory control ratios. These pathologic events are in accord with previously reported increases in myocardial sympathic nerve activity.


Muscle breakdown and lysosomal activation (biochemistry).

Muscle tissue levels of lysosomal catheptic enzymes, such as cathepsins D, A, B1, C, and dipeptidyl peptidase II, were measured in control subjects and patients with muscular dystrophies, polymyositis, and certain denervating diseases. The results show that, in general, the activities of these enzymes are increased in muscles of patients with muscular dystrophies and other diseases. The increases in cathepsin D and autolytic activities are not significant until the late stage of the disease process. Cathepsins A, B1, and C are, however, significantly elevated in mildly affected dystrophic and other diseased muscles. Of these catheptic enzymes, cathepsin B1 displays the highest rise at an early stage, suggesting that it may be one of the rate-controlling enzymes of proteolysis. Dipeptidyl peptidase II is increased slightly in dystrophic and other myopathic muscles but is unchanged in denervated muscle. These data clearly implicate the lysosomal group of proteinases as largely responsible for mediating muscle breakdown in the muscular dystrophies and certain other muscle and neuromuscular diseases in man.


Thymic changes in muscular dystrophy and evidence for an abnormality related to prostaglandin synthesis or action.

In Bar Harbor 129 dystrophic mice, thymic development is abnormal. Before weaning, the thymus is slightly smaller than in phenotypically normal littermates; after weaning, however, the lymphoid elements undergo rapid atrophy. The epithelial elements, in contrast, display hyperlasia. Thymectomy has no influence on the course of the disease, and it is possible that the thymic changes are a reflection of a fundamental metabolic abnormality. Thymic lymphoid tissue development seems to require normal levels of PGE1. Levels that are either too high or too low both result in abnormalities. We have investigated the effects of PGE1 in smooth muscle and have demonstrated that while some PGE1 is required for both calcium release and calcium removal, high levels of PGE1 block both processes. We propose that the muscular dystrophies are related to defects in PG synthesis and action. Myotonic dystrophy may be due to PGE11 excess, whereas Duchenne dystrophy may in part be due to PGE1 deficiency.


Mosaic analysis of dystrophic embryos aggregated with normal chimeras: an approach to mapping the site of gene expression.

Genotypically dystrophic muscle in mouse chimeras of dystrophic leads to and comes from normal genotype has been influenced to develop normally and remain healthy. A significant extramuscular component that effects the expression of the muscle disease in homozygous dystrophic mice is thereby implicated. The potential application of the chimera preparation in further elucidating the source and the nature of that extramuscular influence is outlined.


The changing role of surgery for pulmonary metastases.

From 1960 to 1977, 663 resections for pulmonary metastases were performed in 448 patients, 202 with a sarcoma and 246 with a carcinoma. The majority of the patients (70%) had wedge resection or segmentectomy. Operative mortality was 1.0% (7 patients in 663 thoracotomies). With the increased effectiveness of chemotherapy in some specific areas--osteogenic sarcoma and carcinoma of the testis, breast, and colon--the role of surgery is changing. Surgery is now indicated to establish the histology of a solitary lesion, resect metastases unresponsive to chemotherapy, and to reclassify lesions that stabilize but do not disappear totally with chemotherapy.


Severe hypokalemia in hospitalized patients.

Profound hypokalemia was observed in 73 patients in a major university teaching hospital during a three-year period. When compared with hospitalized subjects used as controls, these patients experienced a greater mortality, were substantially more likely to be female, but were not more likely to suffer from cardiovascular disease. Use of a diuretic appeared to precipitate profound hypokalemia infrequently, and when it did, the clinical situation was extremely complex. Over 10% of the patients with hypokalemia had acute myeloid leukemia, an incidence 22 times greater than that expected. Hypokalemia should be sought in all patients with this disease, since it is an avoidable cause of death. Further studies into the mechanism of hypokalemia are required to explain its striking preponderance in women.


Osteosarcoma: histological evaluation and grading.

With 60 cases of osteosarcomas a histological evaluation from + to +++ carried out for mitoses, osteoid formation, presence of multinucleated giant cells, and tumor necrosis. A subclassification in osteoblastic, chondroblastic, and fibroblastic type of osteosarcoma (according to Dahlin) and a histological grading from + to +++ based on degree of cellular atypism was also done. In our material no relations between these three types of osteosarcoma and chance for survival became evident. There was, however, a significant correlation between grade of atypism and rate of mitoses. Grading of oestosarcomas from + to +++ showed that cases with grade III osteosarcoma remained only seldomly without metastases during the course of the disease. Grade I osteosarcomas and also grade II tumors showed a higher number of patients with 2-year survival. However, neither correlation between tumor grade and incidence of metastases, nor with chances for survival were statistically significant. Nevertheless, characterization of osteosarcomas, by a histological grading  from + to +++ based on cellular atypism and mitotic count is advisable, in addition to the TNM stages. This histological grading appeared to be more practicable than subclassifications of osteosarcoma by type which had been tested by us in a previous study (Konrad et al., in press).


The diagnosis and management of post-traumatic pain syndromes (causalgia).

There are two major categories of post-traumatic pain syndroms: (1) causalgia; and (2) mimocausalgia states or reflex sympathetic dystrophy. Vasoconstriction is usually present. Because of the pain, limitation of motion of the extremity occurs, and may result in permanent disability. There is often a great disparity between the apparent trauma and the severity of the pain. Sympathetic blocks and sympathectomy are definitive modes of therapy. In a series of 147 patients, 56% required surgical sympathectomy. The rest were treated by sympathetic blocks, physical therapy, and other medical measures. Eighty-two percent had excellent relief of pain, 11% had good relief, while 7% had no relief. Thirty-one percent of patients had residual symptoms resulting from the original injury, or from irreversible occurrences on the basis of pain and trophic changes. Emphasis is placed on early recognition and proper treatment.


The carcinoid tumour.

Carcinoid tumours are by no means rare. The wide range of sites in which they occur is explained by their origin from APUD cells of the neural crest. These cells migrate to all parts of the alimentary tract during embryonic life, and ultimately are found as well in various gut derivatives such as the respiratory, pancreatic and biliary systems. On the basis of a series of 31 carcinoid tumours seen at the Royal Prince Alfred Hospital in a five-year period, the distinctive clinical and histological features of carcinoids of foregut, midgut and hindgut origin are reviewed. Diagnosis, treatment and results are discussed, and recommendations regarding management of the patient with a carcinoid tumour are given.


The current status of surgery for endometrial carcinoma: facts and fantasy.

Surgery is the prime method of therapy for endometrial carcinoma. However, in nearly all cases radiotherapy is combined with it either before or after operation. High risk factors include hyperoestrinism, cervical spread, myometrial invasion, cellular anaplasia, and metastatic spread to adnexa, vagina and the pelvic lymph nodes. The latter involvement of the last factor is analysed in some detail, on the base of 216 dissections with an incidence of 8%. Analysis of other authors' findings are reviewed on the basis of autopsy and selection. The place for Wertheim hysterectomy is discussed, also vaginal hysterectomy and the timing of surgery when irradiation is given preoperatively. The author's statistics are derived from a previous study of 468 patients treated between 1956 and 1971.


Preoperative basal chemotherapy in the management of cancer of the stomach: a preliminary report.

Nine patients with advanced gastric carcinoma have been treated with a programme of chemotherapy as the first stage of management with the objective of reducing tumour extent and viability in preparation for subsequent surgery where feasible. In eight patients the chemotherapy was given by intraarterial infusion into the coeliac axis, and the remaining patient was given intravenous chemotherapy. Most patients gained symptomatic improvement, including pain relief, and in seven patients tumour regression was achieved. In six patients tumour regression was followed by gastrectomy. Residual tumour was found in five of these six patients, and was not found in one.


The survival of patients with malignant melanoma receiving BCG with or without chemotherapy.

The effects of treatment by immunotherapy and chemoimmunotherapy were assessed in 31 non-randomized patients with melanoma; 16 received only BCG and 15 BCG and chemotherapy. For advanced cases, the times of survival for the two treatment groups did not differ significantly, nor did there appear to be any improvement in survival over that recorded for the natural course of the disease. The pretreatment immune status as judged by hyporeactivity or normal reactivity to skin tests for delayed type hypersensitivity did not appear to influence survival. This study, together with other reports, does not support the use of immunotherapy in advanced melanoma. Immunotherapy for early melanoma is still to be assessed.


Ileostomy reconstruction.

A study of 47 patients undergoing ileostomy reconstruction is presented. The most common indications were recession (15 patients) and a desire for a continent type of ileostomy (12 patients). Less frequent indications were stenosis (6 patients), parastomal ulceration (6 patients), prolapse (4 patients), unsatisfactory siting (3 patients), and parastomal hernia (1 patient). Refashioning of the ileostomy at the same site was possible in 17 patients, whilst repositioning at a new site was required in 30 cases. In 28 of these laparotomy was carried out to enable repositioning, but in two cases resiting was performed without laparotomy. After the original operation, reconstruction may become necessary at any time from a few months to over 20 years.


The surgical treatment of anal incontinence.

This study is review of 31 patients undergoing surgery for anal incontinence. Three groups of patients are defined--those with incontinence due to trauma (nine patients), to a combination of trauma and degeneration (five patients), and to degeneration alone (17 patients). Two surgical techniques were used--either a direct repair of the anal sphincter or a postanal repair of the levator ani muscles and external sphincter (Parks operation). In the trauma group and the combined group the more common method used was a direct repair (ten patients)--five underwent a Parks operation. In the degeneration group all but one patient underwent a Parks operation. A defunctioning proximal colostomy was carried out in only four patients--all with incontinence due to trauma. Satisfactory continence was restored in 80% of these patients. Although this is a small series, the results are considered worthwhile and greater awareness and use of the above technique is recommended.


Haemangiopericytoma: problems in diagnosis and management.

Three cases of haemangiopericytoma with diverse modes of presentation are reported. The difficulties with clinical diagnosis are emphasized. There is no consensus on the best mode of treatment, and we have chosen radical surgical excision in the first instance, but have not hesitated to employ radiotherapy or chemotherapy as adjunctive treatment if the need has arisen. The clinical behaviour of this tumour is unpredictable; therefore the prognosis for life must remain uncertain.


Lysis of a superior mesenteric artery embolus following local infusion of streptokinase and heparin.

The successful lysis of a superior mesenteric artery embolus with streptokinase and heparin infused locally through catheter selectively placed in the superior mesenteric artery is described. There was minimal morbidity, and the hazards of surgical embolectomy were avoided.


Intercostal herniation of abdominal contents following a penetrating chest injury.

A case of intercostal herniation of the greater omentum occurring 36 years after a penetrating chest injury is presented. The hernia was successfully treated by operative reduction and repair of the diaphragm and chest wall. This rare complication of thoracic injury is discussed and the literature reviewed.


Colostomy closure: technique and morbidity.

A personal retrospective series of 100 consecutive colostomy closures performed between 1968 and 1978 is reviewed. Serious intraabdominal complications occurred in three patients. The total complication rate in this series was 29%. There were no deaths and no faecal fistulae. However, wound infection occurred in 22 patients.


Anticancer centres in France.

The system of anticancer centres in France is described, with a more detailed description of the largest of these, the Institute Gustave Roussy at Villejuif. The anticancer centres between them see and treat 20% to 25% of the cancer patients in France, control over 4,000 inpatients beds, and see over 75,000 new outpatients annually. The centres are staffed by a full-time multidisciplinary team, divided into "communittees" which deal with each individual type of malignancy. The committees have full secretarial and research staffs and regularly evaluate their progress at symposia. They provide a standard of excellence for the oncological services in France.


Do surgical packs cause peritoneal adhesions?

In spite of the growing variety of materials being used in the manufacture of intraabdominal packs (sponges), no data have been published on their adhesion-producing properties. We have shown that the Porton rat will reliably produce peritoneal adhesions in response to ischaemia and glove powder. In a randomized control trial using this rat model, we tested the adhesogenic potential of two commercially available surgical packs. Both brands of pack were shown to cause a significant incidence of postoperative peritoneal adhesions (P is less than 0.005), irrespective of whether the packs were used wet or dry. It is recommended that the adhesogenic potential of all products for use within the peritoneal cavity be established in an animal model prior to marketing.


[Generalized vaccinia in a child with acute leukemia].

The authors present a girl suffering from acute lymphoblastic leukaemia, which was diagnosed, after she was given the antivariolic vaccina. The clinical flow was very rapid, and was in the fulminant shape, which was presented in from of generalized vaccinia. Although the adequate therapy was given, according to the protocol for the treatment of ALL(08LA74), the child died on for the eight day of hospitalization. There was the evident immunodeficiency in our patient, and it is know that the vaccina with the alive viruses is contraindicated in the imunodeficietic diseases.


Family studies in acute leukaemia in childhood: a possible association with autoimmune disease.

Medical histories of themselves and their first-degree relatives were obtained from parents of 82 leukaemic children (54 acute lymphoblastic (ALL), 28 acute myeloblastic (AML)) and from control couples matched for age. The possibility of a primary familial immunological abnormality as an aetiological factor in childhood leukaemia was suggested by binding some infections significantly more frequently reported in parents than in controls, but more strongly supported by the finding of a significantly (P less than 0.02) increased prevalence of disorders associated with autoimmunity (but not of other conditions such as peptic ulceration, infective hepatitis, tuberculosis or malignancy) amongst members of ALL families compared to those of controls. Analogy with Down's syndrome and the strain of NZB mice, in which diminished T-cell function is associated with autoimmune disease and lymphoid neoplasia, is discussed. Varicella and herpes zoster occurred respectively in 2 ALL mothers during their pregnancies involving the patients and in none of the other 388 pregnancies here reported. This supports previous evidence that antenatal varicella infections may be of aetiological importance in some cases of ALL.


The penetration of misonidazole into spontaneous canine tumours.

The hypoxic cell-radiosensitizing drug misonidazole (1-(2-nitroimidazol-1-yl)-3-methoxypropan -2 -ol, Ro 07-0582, MIS) was administered at a dose of 150 mg/kg i.v. to 6 dogs bearing spontaneous tumours, and the resulting tumour concentrations were measured to HPLC analysis. In 4 dogs it was possible to obtain serial biopsy specimens up to 5 h. With the exception of a brain tumour, the tumour concentrations ranged between 47% and 95% of the plasma concentration, most of the values falling within the range 50--70%. Concentrations in the brain tumour were markedly lower. Barbiturate anaesthesia was necessary for the removal of the serial biopsy specimens, and the effects of sodium pentobarbitone anaesthesia on the pharmacokinetics of MIS were investigated in 2 dogs. After barbiturate anaesthesia peak plasma concontrations were raised and the availability of MIS was increased, although the biological half-life remained unaltered. The metabolism of MIS to the O-demethylated metabolite, Ro 05-9963, was delayed initially. The concentrations of MIS AND Ro 05-9963 in cerebrospinal fluid were also recorded in these dogs; MIS concentrations were found to approach those of the plasma, whereas the metabolite concentrations were considerably lower (0--58% of the plasma concentration).


Membrane receptors of human leukaemic myeloid cells: sequential expression of the gamma Fc receptor.

An immunological surface marker study was performed on 13 patients with a variety of myeloid leukaemias. It was shown that expression of the receptor for the Fc of IgG (gamma FcR) starts to take place at the promyelocyte stage, and that the receptor is present on more mature granulocytic cells, but is absent from myeloblasts. Myeloblasts and promyelocytes are negative for the complement receptor CR2. Monoblasts, unlike myelobasts, were shown to express a gamma FcR and, to a lesser extent, CR2. Receptor expression therefore appears to be an earlier event in monocytic development. The possible diagnostic value of immunological marker studies in myeloid disorders is considered.


Myelofibrosis in chronic granulocytic leukaemia.

Serial trephine biopsies were performed in 45 cases of chronic granulocytic leukaemia (CGL) in order to determine the frequency and significance of secondary myelofibrosis in the evolution of the disease. Histological changes were graded 1-5b, ranging from no increase in reticulin to dense osteomyelosclerosis. Many cases showed a progressive increase from Grade 1 to Grade 3, and accelerated disease, or blast crisis, often supervened when Grade 3 changes were present. However, a significant number of cases showed Grade 4 and 5 changes, which were indistinguishable histologically from those found in agnogenic myeloid metaplasia (AMM) (idiopathic myelofibrosis), at the time of diagnosis. These patients did not always show a rapidly fatal course and may be considered as an example of 'transitional myeloproliferative disorder', with features intermediate between CGL and AMM.


Acute leukaemia relapse presenting as ovarian tumour.

Relapse of acute lymphoblastic leukaemia is described in a woman with a leukaemic ovarian tumour from which reseeding of the bone marrow had occurred. It is proposed that irradiation of the ovaries with the initial leukaemic therapy may prevent this form of relapse.


Oral Crohn's disease and related conditions.

It has become widely recognised that oral lesions may occur in patients with Crohn's disease of the lower gastro-intestinal tract. Patients have also been described with oral lesions of this kind unassociated with gut lesions. The purpose of this paper is to describe the clinical presentation of seven such patients. The resemblance of their lesions to those of the condition known as chronic granulomatous cheilitis is pointed out. The association between the oral lesions and those of the lower gut is discussed and it is reported that in one patient acute toxic dilation of the colon due to Crohn's disease followed a period in which oral lesions only were recognised.


Degenerative disease of the temporomandibular joint in young persons.

The majority of cases of temporomandibular joint pain that are referred to the consultant dental surgeon are diagnosed as pain-dysfunction syndrome, a term first suggested by Schwartz (1959) and now probably the most widely accepted. Another relatively common problem is degenerative disease or osteoarthrosis, and although this generally affects an older age group than pain-dysfunction syndrome, its occurance in the younger patient is by no means a rarity and is further evidence that the two conditions are expressions of the same problem, that is repetitive overloading of the joint. It is proposed that this should be termed mandibular stress syndrome.


Pathological conditions involving the maxillary sinus: their appearance on panoramic dental radiographs.

Panoramic dental radiography does not replace conventional techniques for viewing the maxillary sinuses but is a useful adjunct. Unsuspected antral diseases, from innocuous mucosal cysts to insidious squamous carcinoma, may be detected during routine use of this procedure.


Osteomyelitis of the mandible as a complicating factor in Paget's disease of bone.

A case of osteomyelitis of the mandible in a patient with extensive Paget's disease of bone is presented. The changes in the bone with Paget's disease makes the diagnosis, clinical assessment and management of the osteomyelitis in such patients a difficult task.


Central giant-cell granuloma of the jaw - a hormonal influence.

A case is reported of the recurrence of a central giant-cell granuloma during pregnancy, six years after removal. It is suggested in view of possible hormonal reactivation, that careful follow-up is necessary for women of child-bearing age presenting with this type of lesion.


Warty dyskeratoma. A note concerning its occurrence on the oral mucosa, and its possible pathogenesis.

A case of warty dyskeratoma occurring in the oral mucosa is presented. Indirect immunofluorescence tests using the patient's serum showed the presence of IgG class antibodies reactive with intercellular material of guinea-pig lip mucosa and IgM class antinuclear antibodies. The patient did not have any clinical histopathological, haematological or serological evidence of other autoimmune disease.


Metronidazole in the prevention of 'dry socket'.

Prophylactic metronidazole was found to be an effective means of preventing 'dry socket' after routine dental extractions. The oral anaerobic bacterial may be implicated therefore in the development of the disorder. It has been confirmed in this study that 'dry socket' occurs following three per cent of routine dental extractions and almost exclusively in the mandible. The causes of the condition are probably numerous and may even vary from patient to patient, but the control of infection by anerobic organisms may be important in its prevention or early resolution. The prophylactic administration of metronidazole (Flagyl) has been shown to be a simple and effective method of prevention which would suggest the implication of anaerobic organisms in 'dry socket'. The drug appears to be free from side effects when a dosage of 200 mgs eight hourly for three days is given.


An apparatus for measuring the forces of dental extraction.

An apparatus is described which measures compressive and rotational forces during the extraction of teeth. It has been of value in propaedeutic and clinical instruction.


Characterization of lysozyme synthesized by differentiated mouse myeloid leukemia cells.

Lysozyme was induced by dexamethasone during normal differentiation of cultured mouse myeloid leukemia cells (M1) to macrophages and granulocytes. A large amount of lysozyme was produced by macrophage-like line cells (Mm-1), established from spontaneously differentiated macrophage-like cells from a clonal line of M1 cells. Lysozyme purified from the culture medium of these Mm-1 cells (Mm-1 lysozyme) had a molecular weight of 15,000, as determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis, and showed maximal activity at pH 6.6 with an optimal NaCl concentration of 0.04 M. Its mobility on polyacrylamide gel electrophoresis at pH 4.5 was distinctly lower than those of lysozymes from hen egg white and human urine. Rabbit anti-Mm-1 lysozyme serum inhibited the activities of lysozyme preparations from peritoneal macrophages of normal mice and rats and dexamethasone-induced differentiated M1 cells, but not those of preparations from hen egg white and human urine. Lysozyme was also purified from normal mouse lung, which is rich in alveolar macrophages and was found to be similar to lysozyme purified from the culture medium of Mm-1 cells in size and electrophoretic mobility and in its pH optimum, trypsin peptide map, and antigenicity. Thus the molecular structure of the lysozyme induced in differentiated mouse myeloid leukemia cells is similar to that of lysozyme produced by normal cells.


De novo synthesis of purine nucleotides and metabolic availability of phosphoribosylpyrophosphate in leukemic leukocytes.

Among normal peripheral blood leukocytes, lymphocytes were found to contain most of the de novo purine synthesizing capacity. The rate of purine synthesis de novo was accelerated in leukocytes from patients with acute and chronic myelocytic leukemias, chronic monocytic leukemia, myelofibrosis and plasma cell leukemia, but was normal in most patients with chronic lymphocytic leukemia. The rate of de novo purine synthesis exhibited positive correlation with the percentage of immature cells in the leukocyte population. The metabolic availability of phosphoribosylpyrophosphate (PRPP) exhibited positive correlation with the state of de novo purine synthesis. These finding suggest that the accelerated rate of de novo purine synthesis and the increased metabolic availability of PRPP are characteristic properties of the immature leukemic granulocyte.


Cytoplasmic labelling of eosinophils with tritiated thymidine triphosphate.

A new technique which detects the presence of DNA polymerase and primer-template DNA by measuring the incorporation of 3H-thymidine-5-triphosphate (3H-TTP) showed cytoplasmic labelling of eosinophilic granulocytes and eosinophilic myelocytes in normals, in acute leukaemia, in chronic myeloid leukaemia and in patients with eosinophilia of unknown origin.


Correlation between prognosis and bone marrow chromosomal patterns in children with acute nonlymphocytic leukemia: similarities and differences compared to adults.

The chromosomal complement of 28 children with the diagnosis of acute nonlymphocytic leukemia (ANLL) were examined. An abnormal cytogenetic pattern was found in 50% of these patients, which is similar to the results in adults with ANLL. Unlike the reports in adult patients, however, no specific chromosomal changes were found. This observation may imply that the etiology and mechanisms by which abnormal clones develop in ANLL could differ significantly between children and adults. Those patients with chromosomal abnormalities in their initial bone marrow sample had a median survival of 7.1 mo, whereas those with a normal diploid pattern in their bone marrow had a median survival of 20.5 mo (1-sided, p = 0.04). If all metaphases were abnormal, the median survival was only 3 mo.


Pseudo-Chediak-Higashi anomaly in a case of acute myeloid leukemia: electron microscopic studies.

The formation and fine structure of giant granules in neutrophil promyelocytes of a patient with a variant of acute myelogenous leukemia were investigated by electron microscopy. The patient presented with large lymph nodes and disseminated intravascular coagulation (DIC). By light microscopy, numerous giant granules, resembling those of Chediak-Higashi syndrome (CHS), were present, but Auer bodies could not be found. By electron microscopy, these giant granules were seen to be formed by fusion of azurophilic granules, as in CHS; however, they were different from the large granules of CHS, since they contained numerous microcrystalline structures like those of Auer bodies. However, the crystalline cores of these granules exhibited a periodicity different from that of Auer bodies of acute promyelocytic leukemia. This clinical and hematologic syndrome (giant granules, enlarged lymph nodes, and DIC may represent a variant of acute promyelocytic leukemia.


Stability of alpha and beta globin messenger RNA during induced differentiation of mouse erythroleukemia cells.

Murine erythroleukemia cells (MELC) are induced to express erythroid differentiation when cultured with hexamethylene bisacetamide (HMBA). Newly synthesized alpha and beta globin mRNA are both relatively stable, half-life (t1/2) greater than 50 hr, early in the course of induced differentiation. In fully induced cells there is a decrease in stability of both newly synthesized alpha and beta globin mRNA. The decay of alpha mRNA is faster, (t 1/2, 10--12 hr) than beta globin mRNA (t1/2, 20--22 hr). Thus, differences in stability of alpha and beta globin mRNA plays a role in determining the ratio of alpha to beta mRNA content in differentiated erythroid cells.


[On the existence of a myeloproliferative factor in patients with a myeloproliferative syndrome (author's transl)].

Serum of patients suffering from a chronic myeloproliferative disorder (polycythaemia, era, osteomyelofibrosis, chronic myeloid leukaemia) and serum of lethally irradiated rats injected before application of a single doses of erythropoietin did not enhance the effect of erythropoietin -- measured with the iron incorporation rate of polycythemic mice. The rationale for these experiments is to try to find a "myeloproliferative factor", which augments the number of stem cells as described in sera of patients with polycythaemia vera, osteomyelofibrosis, and lethally irradiated mice.


Chronic myelomonocytic leukemia: light and electron microscopy of the bone marrow.

Clinical data and light and electron microscopic findings are presented in a patient with chromic myelomonocytic leukemia of about 5 years' duration and no need for specific therapy. Cytogenetic studies failed to demonstrate a Philadelphia-chromosome. The leading clinical symptoms were anemia, moderate hepatomegaly, and leukocytosis with monocytes in the peripheral blood count. Light microscopy of bone marrow cores showed hypercellularity of neutrophil granulocytic and monocytic cell lines including some precursor forms. Electron microscopy confirmed the existence of a biphasic myelomonocytic cell proliferation with predominance of mature forms in both lineages; there were no gross cellular abnormalities and no "hiatus leukaemicus". Consupicuous were cells of an undeterminated origin apparently neither belonging to the neutrophil granulocytic nor monocytic series and large histiocytic cells, possibly corresponding to the so-called sea-blue histiocytes of light microscopy. The high degree of maturation of both cell lines in the bone marrow is in accordance with the relatively benign and prolongated course of this rare type of leukemia.


Gilles de la Tourette's syndrome: report of five cases in the Chinese.

Five cases of Gilles de la Tourette's syndrome occurring in the Chinese are described. The onset, course, symptomatology and family psychopathology are similar to those reported in Caucasians. On the parameters of APGAR score, psychological testing, EEG and psychiatric examination all had at least one abnormality. The response to haloperidol was uniformly good. Follow-up results showed that all were able to lead a fairly normal life after treatment. Though the cases are few in number, the findings seem to support the hypothesis that the syndrome has an organic substratum subject to psychological influences.


Chromosome 1 in 26 carcinomas of the cervix uteri: structural and numerical changes.

Cytogenetic studies on 26 carcinomas of the cervix showed that chromosome 1 was consistently involved in the changes: either one or more structurally abnormal chromosomes or a relative excess of normal chromosomes were present. Several types of structural change were repeatedly seen: short arm deletions (1p-, in seven tumors); long arm isochromosomes (i(1q), in six tumors); and translocations of unidentified chromosomal material onto one of the arms (possibly in eleven tumors; in four of these, there was an additional C-band on the long arm). In one tumor, there was a short arm isochromosome (i(1p)). The most consistent feature of the aneuploid complements of these tumors appeared to be the presence in excess of the centromeric region and at least part of the adjacent heterochromatin of chromosome 1.


Brain tryptophan and the neoplastic anorexia-cachexia syndrome.

The cause of anorexia associated with neoplasia is unknown, and some investigators have suggested a central mechanism. Recent neurophysiologic studies have revealed the possible role of serotoninergic system involving tryptophan (TRP) and its indole neurotransmitter metabolites in regulating particular aspects of feeding behavior. We therefore studied plasma and brain factors affecting TRP transport through the blood-brain barrier (plasma free and total TRP, albumin, nonesterified fatty acids, plasma neutral amino acids, brain uptake index [BUI] for TRP) and central serotonin metabolism (5-HT, 5-HIAA) in young, anorexic rats bearing the Walker-256 tumor injected intramuscularly. Plasma free TRP, but not plasma total TRP, and, more important, brain TRP and brain 5-HIAA were significantly higher in tumor-bearing rats than in pair-fed control animals. The results suggest an association between altered brain TRP metabolism and feeding behavior in tumor-related anorexia.


Prognostic factors affecting remission, remission duration, and survival in adult acute nonlymphocytic leukemia.

The medical records of 94 consecutive patients with acute nonlymphocytic leukemia (ANLL) were reviewed to identify significant prognostic factors. The data were analyzed using 1) Cox's linear hazard and linear logistic models, 2) chi-square comparison of the groups living longer than 2 years and those living less than 2 years, and 3) the Gehan-Breslow test of equal survival curves. The only statistically significant finding was that the presence of promyelocytic cell type and complete remission correlated with increased survival (p less than .05), but this was negated by the small number of patients with this cell type. There was a suggestive association between higher initial hemoglobin and survival (p = .09). The Gehan-Breslow test revealed a possible difference in survival between those patients more than 51 years of age and those less than 51 (p = .10). Thus none of the commonly accepted prognostic factors in acute nonlymphocytic leukemia was definitely shown to be useful. The findings of this study support an aggressive approach toward all patients with this disease.


Improved survival in young children with acute granulocytic leukemia treated with combination therapy using cyclophosphamide, oncovin, cytosine arabinoside, and prednisone.

Seven of 17 children (41%) under 5 years of age with acute granulocytic leukemia (AGL) treated with either cytosine arabinoside-cytoxan (CA-CYT) or Mini-COAP (CA-CYT with vincristine sulfate [VCR] and prednisone) have been in continuous complete remission 4 years or more. CA and CYT were each given in the dosage of 120 mg/m2 intravenously, daily in 3 divided doses, for 4 days. Induction consisted of two courses given at intervals of 2 weeks; during maintenance the courses were repeated at intervals of 4 weeks. In the Mini-COAP regimen, standard 28-day VCR-prednisone therapy was superimposed on CA-CYT induction and 4-day VCR-prednisone pulses were superimposed on CA-CYT maintenance. Transient moderate to severe myelosuppression was frequent; other manifestations of toxicity were mild. Administration of drugs at home was feasible in many instances. Mini-COAP was proved to be an effective therapeutic regimen for young children with AGL and should be considered as initial therapy.


Ultrastructure and cytokinetics of leukemic myeloblasts containing giant granules.

Leukemic myeloblasts containing abnormal granules were studied with ultrastructural, cytochemical, and thymidine labeling techniques to evaluate defects in granulogenesis and proliferation. Giant granules (1 to 3 micron in diameter) and Auer rods were observed in leukemic cells from two patients, and only rarely were both abnormal granule types observed in the same cell. The lysosomal origin of these abnormal granules was demonstrated by their content of peroxidase, esterase, and anionic glycoconjugates. Fusion of small dense granules (less than 0.2 micron in diameter) appeared to be increased in cells containing Auer rods and/or giant granules, but fusion of intact primary granules (0.2 to 0.4 micron in diameter) and sequestration of cytoplasmic contents were observed only in giant granules and not in Auer rods. Although the small granules that fused to form giant granules and Auer rods appeared similar, there was no evidence for transformation of giant granules into Auer rods. In one patient, cells with abnormal granules could easily be distinguished from the larger population of cells that lacked abnormal granules. The perturbation of these two distinct populations by chemotherapy was evaluated with thymidine labeling experiments. A high percentage (2- or 3-fold greater) of the abnormally granulated myeloblasts incorporated tritiated thymidine when compared to myeloblasts without abnormal granules in the same specimen. This difference could have resulted from an underlying metabolic defect which affected both granulogenesis and cell division. These results demonstrate that the formation of giant granules in leukemic cells is morphologically similar to that observed in the Chediak-Higashi syndrome and that leukemic cells with abnormal granules may differ cytokinetically from uninvolved leukemic cells.


Inhibition by dexamethasone of commitment to erythroid differentiation in murine erythroleukemia cells.

The inhibition of erythroid differentiation of murine erythroleukemia cells by dexamethasone (DEX) has been investigated on a clonal basis. At concentrations which had no detectable effect on cell proliferation, DEX3 rapidly inhibited the dimethyl sulfoxide (DMSO)-induced commitment of individual murine erythroleukemia cells to the differentiation program. DEX did not prevent heme accumulation in cells already committed to the differentiation process. The rate of globin messenger RNA (mRNA) synthesis was reduced in cells treated with DMSO and DEX compared to cells treated with DMSO alone. The reduction in the rate of globin mRNA synthesis was proportional to the reduction caused by DEX in the rate of commitment. DEX inhibition in the rate of commitment and of globin mRNA synthesis of DMSO-treated cells was reversible. Upon removal of DEX, continued DMSO treatment resulted in a rapid increase in both the rate of globin mRNA synthesis and the rate of commitment. The rate of globin mRNA synthesis after DEX release was also proportional to the rate of commitment. These results suggest that DEX exerts an inhibitory effect on heme and globin synthesis by blocking commitment to terminal erythroid differentiation.


Dimethyl sulfoxide-induced differentiation of Friend erythroleukemia cells in the absence of cytokinesis.

Friend erythroleukemia cells grown in culture and induced to differentiate along the erythroid developmental pathway by dimethyl sulfoxide (DMSO) were used as a model system to investigate the requirement for cellular replication to express a differentiated erythroid phenotype. That cytokinesis is not essential for DMSO-induced erythroid differentiation as measured by the synthesis and accumulation of hemoglobin was shown by experiments using cytochalasin B. In these studies, hemoglobin was found to accumulate in Friend cells treated simultaneously with DMSO and cytochalasin B; such treatment caused cells to become enlarged and multinucleated due to inhibition of cytokinesis by cytochalasin B. In contrast, exposure of cells to cytochalasin B for at least 48 hr prior to DMSO caused significant inhibition of erythroid differentiation. The findings support the concept that cellular division and, thereby the production of new cellular types are not required for gene activation and the expression of an erythroid phenotype. These effects of cytochalasin B on DMSO-induced differentiation of Friend leukemia cells also suggest plasma membrane-cytoskeleton involvement in the initiation of the erythroid maturation process in this system.


Stimulation of differentiation of mouse myeloid leukemic cells and induction of interferon in the cells by double-stranded polyribonucleotides.

Mouse myeloid leukemic MI cells can be induced to differentiate into mature macrophages and granulocytes by differentiation-stimulating factor (D-factor) in conditioned medium of mouse peritoneal macrophages. Double-stranded RNA's, such as the copolymers of polyinosinic and polycytidylic acids and polyadenylic and polyuridylic acids, could not alone induce differentiation of the cells, but enhanced induction of differentiation by low concentrations of the D-factor and induced a significant amount of interferon. Rabbit antiserum to purified L-cell interferon neutralized the antiviral activity of interferon of MI cells. Simultaneous treatment of MI cells with the anti-interferon serum and copolymer of polyinosine and polycytidylic acids and D-factor abolished the enhancing effect of copolymer of polyinosine and polycytidylic acids on the action of the D-factor. These results suggest that the effect of double-stranded RNA's on induction of differentiation of MI cells is mediated by interferon produced by the cells.


Isolation of thymidine-resistant cells from a thymidine-sensitive acute lymphoblastic leukemia cell line.

Malignant cells have enhanced sensitivity to inhibition of growth by thymidine. Cell growth of the permanent lymphoid cell line CCRF-CEM, originating from a patient with acute lymphoblastic leukemia, is inhibited by 3 x 10(-5) M thymidine, compared to 1 to 5 x 10(-3) M thymidine required to inhibit growth of normal lymphoid lines. Thymidine-resistant cells were isolated at a frequency of approximately 1/100,000 cells after cloning CCRF-CEM cells in medium containing 5 x 10(-4) M thymidine. The resistant cells lacked the enzyme thymidine kinase, had a 20-fold decrease of thymidine uptake, and were resistant to 1 x 10(-4) M 5-bromo-2-deoxyuridine. The cells were sensitive to 1 x 10(-5) M methotrexate, even in the presence of exogenously added thymidine and hypoxanthine. The data indicate that a small fraction of malignant cells may escape the toxic effect of high thymidine therapy and therefore, require additional chemotherapy for their control.


Use of vinblastine in the terminal phase of chronic myelocytic leukemia.

Vinblastine (6 mg/m2) was given to 15 patients in the terminal phase of Ph1 chromosome-positive chronic myelocytic leukemia and to one patient with chronic myelomonocytic leukemia. In each of these patients, there was prompt reduction in leukocyte counts (median, 80% decrease). Effects on platelet counts and hematocrit levels were inconsistent. Nine patients had decreases in the percentage of circulating blast cells. Reduction in splenomegaly and relief of bone pain were recorded in patients with these manifestations. Serious leukopenia was induced in only one patient, and was of brief duration. Additional doses of vinblastine at intervals of greater than or equal to 3 weeks were given to eight patients who had shown improvement in the differential cell count, as an adjunct to maintenance schedules of combination chemotherapy. Good results were obtained initially, but the quality and duration of responses decreased after two to six injections.


Reinduction therapy for adult acute leukemia with adriamycin, vincristine, and prednisone: a Southwest Oncology Group study.

In an attempt to improve remissions and survivals in previously treated patients with adult acute leukemia, we gave Adriamycin, vincristine, and prednisone for induction therapy, followed by 6-mercaptopurine and methotrexate for maintenance therapy to patients attaining complete remission (CR). The study group consisted of 18 patients with acute myeloblastic leukemia (AML), ten with acute lymphoblastic leukemia, and one with acute undifferentiated leukemia. Only one patient had previously received Adriamycin. Overall, there were ten CRs and two partial remissions. The five CRs and one partial remission in patients with AML occurred among those with one prior induction attempt; none of the eight AML patients with more than one prior induction attempt responded. The actuarial median duration of CR was 15 weeks and was similar for AML and acute lymphoblastic leukemia patients. Responders had a longer median survival (30 weeks) than nonresponders (9 weeks). Thus, although a reasonable number of responses in previously treated patients were obtained with this program, improvements in maintenance therapy are clearly needed.


Functional cell compartments in a rat model for human acute myelocytic leukaemia.

Functional cell compartments were studied in a rat model for human acute myelocytic leukaemia (AML). This was done by tracing the distribution of injected 51Chromium-labelled leukaemic cells in the body. It was concluded that two functional compartments can be distinguished in acute leukaemia, i.e., a rapidly exchangeable pool of cells (including the circulating blood pool, the marginal noncirculating blood pool and the rapidly exchangeable tissue pool; RETP) and a slowly exchangeable tissue pool (SETP). The sizes of these various compartments were roughly quantified at various stages of the disease by calculations based on the principle of isotope dilution and organ weight measurements. As the leukaemia progresses, the size of the SETP increased significantly relative to the size of the RETP. Simultaneously, the exchange rates of leukaemic cells between the organs and the blood decrease. The blood transit time of leukaemic cells was also significantly prolonged, as is the case in human AML.


Memory of MEL cells to a previous exposure to inducer.

The mechanism of commitment of murine erythroleukemia (MEL) cells to terminal differentiation has been examined. Before a significant proportion of cells becomes committed, a lag period of at least 9 hr of exposure to inducer is observed. Cells withdrawn from inducer can reinitiate commitment without a lag when reexposed. The proportion of committed cells in a culture discontinuously exposed to inducer is identical to that in a continuously exposed culture even if withdrawal from inducer lasts for 18 hr. The ability to tolerate an interruption in the exposure has been termed "memory." The memory of a previous exposure to inducer is complete up to 18 hr. It is partially erased after 36 hr and completely erased after 72 hr. The length of time the memory persists is not affected by the length of the initial exposure to inducer. These results suggest that a cellular component necessary for the commitment event accumulates in response to inducer and that this component has a decay time on the order of 10 hr.


Hereditary perforating ulcers of the foot: "hereditary sensory radicular neuropathy".

In 4 cases of hereditary sensory radicular neuropathy the loss of pain and thermal sensibility resulting in perforating ulcers starts distally in lower extremities and progresses proximally. It has a sporadic and familial form as well as the hereditary type. In siblings inheritance appeared to be autosomal dominant. By early recognition of the disease and removing pressure from the involved areas, or spreading pressure equally over the foot with proper footwear ulcers are preventable.


Preservation of the functional above knee stump following hip disarticulation by means of an Austin-Moore prosthesis.

Patients can be provided with a functional above-knee amputation stump when the tumor is not resectable. In order to do this and still remove the entire upper end of the femur a small Austin-Moore prosthesis with drill holes is inserted and enclosed in long anterior and posterior flaps. Muscle attachments are sutured into the distal stem to obtain the balance between abduction and extension of a functional stump.


Late replication and recombination in the vegetative pool of T4.

The rates and extents of replication are the same for all members of the vegetative pool, whether already residing (progeny) or newly entered (superinfecting). Thus, no member of the pool is sequestered in a replicative complex. Amber N82 infections of nonpermissive host result in extensive breakdown of phage DNA. The extent of fragmentation observed depends on the multiplicity of infection and whether phage ligase is present. Hence, parental DNA suffers single-strand nicks which can be repaired by ligase only if recombination does not interfere. The physiological role of ligase in compensating for such nicks is reemphasized. Superinfecting genomes recombine very rapidly with progeny molecules whose combined lengths are approximately six times that of the superinfecting genomic fragment. The superinfecting phage does not replicate before recombining. Therefore, the lack of replication poses no barrier to efficient recombination.


Aspergillus vegetative endocarditis and complete heart block in a patient with acute leukemia.

Aspergillus flavus vegetative endocarditis together with myocardial abscesses and pneumonitis developed in a patient with acute lymphocytic leukemia. The initial diagnosis was not suspected until 67gallium imaging revealed a radiographically undetectable thoracic abnormality. Despite apparently "early" diagnosis, antifungal therapy was inadequate to prevent disruption of the bundle of His, complete heart block and death.


[Relationship between endodontium and periodontium].

1. The dental pulp and periodontium have developmental connections. 2. Many of their functions intersect and are common to both tissues. 3. Their highly developed defence systems enable either to survive when the other has been destroyed.


Reversed genetics: a new approach to the elucidation of structure--function relationship.

Methods for generating point mutations at predetermined sites of RNA or DNA genomes have been developed. With Qbeta RNA as a template, minus strands were synthesized in vitro in a stepwise, substrate-controlled reaction. The nucleotide analogue N4-hydorxyCMP was introduced in the desired position, the minus strands were completed with the four standard triphosphates and used as templates to synthesize plus strands; about 30% of the progeny plus strands showed a base transition at the position corresponding to the nucleotide analogue. Two mutant RNAs with extracistronic nucleotide substitutions have been generated; one of these was viable, albeit with a reduced propagation rate, while the other was non-infectious. Furthermore, mutants with changes at the initiation codon of the coat cistron were prepared. An analysis of ribosome binding to such mutant RNAs revealed the importance of the A-U-G region for the formation of the initiation complex. With a similar approach applied to the beta-globin complementary DNA (CDNA) plasmid PbetaG, point mutations have been introduced at the positions corresponding to amino acids 121 to 123.


[Results of follow-up studies of endodontically treated teeth based on punched-card records and visual comparison during systematic periodontal treatment].

The relationship between periodontal alterations in the marginal and the apical areas led us to question whether or not a tooth should be conserved when periodontal alterations are present in both areas. Comparison of edge-notched cards showed that the conservation of individual teeth and/or groups of teeth following periodontal treatment does not depend on endodontic care.


[The fine structure of the dental pulp].

Root pulp usually contains more collagen fibrils than coronal pulp. The fibrils consolidate to form fibrinous bundles only to a very slight extent. Involution of the odontoblasts occurs with advancing age. If such involution is absent, an irregular layer of hard substance is deposited on the canal wall. A homogeneous line of adhesive can be seen on the wall at the border with the root pulp. The tissue character of the pulp however is preserved. Perineurium is absent around the nerves in human pulp.


Genetics in an oocyte.

The combination of DNA cloning in bacterial plasmids and DNA injection into frog oocyte nuclei permits a novel type of genetic analysis in which the function of defined sequences of DNA may be more readily and precisely investigated than before. Purified segments of chromosomal DNA containing 5S genes of Xenopus have been injected into the nuclei of Xenopus oocytes and the products of these genes recognized as labelled 5S RNA. Since short linear molecules of DNA are degraded in oocytes, the function of particular regions of DNA near a 5S gene is best determined by excising these regions and joining them to other kinds of DNA. This is achieved most simply by inserting regions of 5S DNA into a plasmid. Our results with alpha-amanitin show that the activity of a 5S DNA promoter inserted into a plasmid can be detected independently of the plasmid's own promoters, using DNA injection into oocytes. The observation that plasmids containing variant 5S genes result in the synthesis of abnormal 5S RNA molecules illustrates the possibility of mutanting recombinant plasmids and then testing the biological effect of these mutations by DNA injection.


[The use of composite filling materials in endodontics (animal experimental, light and electron microscopic studies].

The tissue affinity of a composite used in root canals was studied in beagle dogs. No pathologic tissue response was observed in the areas surrounding the plastic eight weeks later. Newly formed connective tissue bordered the material. Comparative SEM investigations showed the marginal strength of this type of root filling.


[Preparation of not completely accessible root canals by means of depot iontophoresis with an exterior iontrophoresis device].

The two depot ionophoresis processes (depot ionophoresis with the depot ionophoresis device is used here) are shown experimentally and argued theoretically to be capable of dissolving the content of the entire root canal system by alkaline proteolysis and of removing the oligopeptides (peptones) formed from the canal system via the apical foramen by electrophoresis. The canal is then freed from all organic residues. In this way the majority of roots which cannot be prepared mechanically are fundamentally treatable.


[Fluoride concentration of drinking water and fluoride content of the enamel in deciduous teeth].

The fluoride concentrations in the superficial enamel of deciduous teeth of children from areas with fluoridized drinking water (Basel, up to 1.00 ppm F-) and from a fluoride-deficient area (Hamburg, approx. 0.14 ppm F-) were measured and compared. The results of this investigation show that, if optimal accounts of fluoride are available, the fluoride content in the enamel of deciduous teeth is twice as high as that in teeth of children from areas without fluoridation. The relationship between the reduction of caries due to fluoridized drinking water and the significant increase in fluoride concentration in the enamel was demonstrated.


[Comparison of embryotoxic effects of inorganic fluorides].

A comparison of the toxicity of SnF2, BaF2, KF, CaF2, and MgF2 shows that the hard-to-dissolve fluorides CaF2 and MgF2 are absolutely safe. The other fluorides tested showed no toxic effects in dosages relevant for caries prophylaxis and with oral application.


[Solubility and absorption of magnesium fluoride in the intestinal tract].

The solubility rate of various substances was determined via solubility experiments using magnesium fluoride on various specific surfaces. This rate controls the resorption of fluorine ions from MgF2 during its passage through the intestinal tract. The solubility rate for MgF2, as for other hard-to-dissolve substances, is proportional to the specific surface and the mass of the substance. In light of this information, resorption tests with magnesium fluoride showed that this compound is "biodisposable". The amount of fluorine which will be resorbed from MgF2 can be estimated.


[Measurement of the abrasive effect of tooth pastes after oral tooth cleaning experiments].

Since only relative results have been obtained with all in vitro investigations of tooth paste abrasiveness (i.e., dependent on the method of cleaning selected and the evaluation), an in vivo method was described with which absolute values may be obtained in the mouths of subjects participating in the cleaning tests.


[Closing of the filling cleft with copper and mercury compounds in fillings of silver-tin amalgams].

After measuring the tearing pressure of bubbles, the remaining marginal fissures (unavoidable with silver-tin amalgams) were completely eliminated by cauterizing cavities with an activated copper suspension. The effect is based on the activated copper forming voluminous basic Cu compounds. This procedure gives the silver-tin amalgam the bactericidal characteristics of a copper amalgam but essentially higher marginal strength. As expected, the teeth were not discolored. Measurement of mercury vapor showed a distinct decrease in the release of mercury vapor in the direction of the cavity.


[The effect of various ultrasonic tooth cleaning devices on dental filling materials].

The influence of various ultrasonic devices for cleaning teeth on the surfaces of different filling materials was studied in 300 extracted teeth. Special attention was directed to the cavity edge and the area immediately surrounding it. Alterations in surface roughness were determined and compared with an electromechanical stylus. The inflicted damage depends much more on the type of filling material than on the device. Distinct quantitative differences due to the devices however were observable.


Two chromatin fractions with different metabolic properties of non-histone proteins and of newly synthesized RNA.

Digestion of chromatin with micrococcal nuclease under mild conditions results in the release of a minor chromatin fraction showing an increased RNA and non-histone protein content, a fast turnover of the non-histone proteins and the presence of rapidly labelled heterogeneous nuclear RNA (hnRNA) with half-life of about 20 min. Further digestion of the chromatin leads to the elimination of about 19% of the initial chromosomal DNA, thus leaving a second chromatin fraction relatively resistant to nuclease attack. This fraction has a low protein and RNA content and contains only metabolically stable non-histone proteins. No differences in the histone complement of the two fractions was found except for a 40% deficiency of H1 in the minor fraction.


The effect of leukemic human serum on normal granulopoiesis.

Acute lymphoblastic leukemia (ALL) in children is often characterized by defective granulopoiesis during initial and relapse stages of the disease, resulting in absolute neutropenia in vivo and in low or absent production of granulocyte-macrophage colonies in vitro. The purpose of this study was to determine if serum from leukemic children with ALL could inhibit normal granulopoiesis. Several concentrations of serum from 12 leukemic patients were mixed with normal bone marrow cells and co-cultured by the double layer agar technique. Also, serum from normal individuals and from ALL patients in remission and relapse was examined for inhibitors. Cultures without serum served as controls. The majority of ALL (initial, relapse and remission) and normal sera either stimulated or had no effect on colony formation. These groups also had similar percentages of inhibitory sera, with the exception of the somewhat higher levels of inhibition found in the remission group. Thus, ALL serum resembled normal serum in its effect on in vitro granulopoiesis at the committed granulocyte-macrophage stem cell level. It is therefore unlikely that inhibition of in vivo granulopoiesis at the committed level by serum inhibitors is responsible for ALL-associated neutropenia.


[Effect of mexamine on arterial tonus in dogs].

The effect of mexamin (5 and 10 mg/kg) on the vascular tone of thoracic and abdominal cavity vessels and pelvic limbs was investigated by angiography in experiments on 19 mongrel dogs under nembutal anesthesia (30 mg/kg). 5-7 minutes after intramuscular administration of the drug there was a constriction of the aorta, of the hepatic, splenic, cranial mesenteric, internal and external iliac, branched femoral and tibial arteries by about 15-40% as compared to the initial diameter. Mexamin exerted no substantial vasoconstrictive action on the segmental (intercostal, lumbar, phrenoabdominal) and renal arteries.


[Correlation of heredity and environmental factors in the etiology of Vilyui encephalomyelitis. II. A population genetic study in districts of Vilyui encephalomyelitis distribution].

Population-genetic investigation was carried out in the regions endemic for Viljuisk encephalomyelitis (VE). The following indices were estimated: the relationship coefficient, the inbreeding coefficient, the intensity of migration, genetic structure of the population. The aim of the investigation was to explain causes of intrapopulational and, in some cases, of intragenus accumulation of the VE patients. No evidence of isolation or increased inbreeding were found in highly affected populations. The genetic structure of a group of VE patients tested for 9 polymorphic systems did not reveal any deviation from the control group. Several VE cases in healthy populations occured in some years after the immigration of a VE patient. These data confirm the hypothesis that VE is transmitted from a VE patient to healthy persons. Among these persons fall ill those who have a hereditary determined increased sensitivity to VE which results in intrapopulation and intragenus accumulation of VE cases.


The JCAH consolidated standards: questions and answers.

In early 1979 the Joint Commission on Accreditation of Hospitals published a manual consolidating standards for adult psychiatric, child and adolescent, alcoholism, and drug abuse programs. The standards became effective on October 1, 1979. Instead of reviewing separately each kind of program within a facility, surveyors will conduct a simultaneous, four-part survey in which they review all aspects of services related to the four groups of standards: those for program management, patient management (intake, assessment, and treatment plans), patient services, and facility management. The new standards specify a minimum of six kinds of quality assurance activities and stress a clinical staff organization that has developed a comprehensive quality assurance system. They reflect a service-system concept more applicable to a variety of age and disability groups than to the treatment models on which the earlier adult psychiatric and child and adolescent standards were heavily based.


Partial trisomy 1 due to 1/17 translocation in Ph'-positive chronic myelocytic leukemia.

A patient with chronic myelocytic leukaemia (CML) had the Philadelphia chromosome from the standard 9/22 translocation, a partial trisomy 1 secondary to an unbalanced 1/17 translocation, and a more recent clone with the addition of trisomy 22. This is the third case of partial trisomy 1 associated with the Philadelphia chromosome. Trisomy 1 in haematological disorders is discussed with reference to its clinical significance in CML, the segment of chromosome no. 1 involved, and the mechanism of origin of the partial trisomies. Anomalies of chromosome 1, although not specific to any of them, seem to be important in the development of myeloproliferative disorders and of neoplasms in general.


Biochemical genetic markers in the Kadazans of Sabah, Malaysia.

Kadazans, the largest indigenous group in Sabah, northern Borneo, were surveyed for glyoxalase I, phosphoglucomutase I, red cell acid phosphatase, esterase D, adenosine deaminase, soluble glutamate pyruvate transaminase, soluble glutamate oxaloacetate transaminase, 6-phosphogluconate dehydrogenase, uridine monophosphate kinase, adenylate kinase, peptidase B and D, superoxide dismutase, C5, group specific component, haptoglobin and transferrin. Kadazans were found to be polymorphic for GLO I, PGM I, RCAP, esterase D, ADA, s-Gpt, 6PGD, UMPK, Gc, C5, haptoglobin and peptidase B. Rare variants were found for transferrin and peptidase D. No variant was found for s-Got, SOD and AK.


The management of fractures in Paget's disease of bone.

The results of the treatment of 89 fractures of bone affected by Paget's disease are presented. The typical features of these fractures, the common sites affected, the rate of healing and the complications involved, including the incidence of malignant change, are reviewed. The possible role of calcitonin in the prevention of these fractures is discussed.


Demonstration of antibody-associated cellular cytotoxicity in patients with acute myelogenous leukemia before and after chemotherapy.

This study demonstrates that a cytotoxic serum reactivity not requiring the presence of complement appears in the sera of patients with acute myelogenous leukemia. The reaction is detected upon short-term incubation of sera in vitro with autochthonous mononuclear white blood cells from peripheral venous blood of patients at the acute stage of the disease. This reactivity was demonstrated in 18/18 patients. Generally, the cytotoxicity was low in patients at the acute stage of the disease, but increased after chemotherapy and reached the highest level at the onset of clinical remission or just before. No cytotoxicity could be demonstrated against autochthonous remission white blood cells. The serum activity could be absorbed and eluted from protein A-sepharose CL-4B and was recovered in the 7S-fraction of the sera after gel filtration on Sephadex G-200 and ion exchange chromatography. This indicates that the demonstrated cytotoxicity is due to immunoglobulins of IgG-class. It is believed that Fc-receptor-bearing cells present in the target cell preparations function as effector cells. The reaction is designated antibody-associated cellular cytotoxicity (AACC).


Actinomycin D restores in vivo sensitivity to differentiation induction of non-differentiating mouse myeloid leukemia cells.

Resistant mouse myeloid leukemia cells could not be induced to differentiate in vitro into mature macrophages and granulocytes by incubation with ascitic fluid or dexamethasone as inducer. Neither could endogenous inducers acting on resistant cells maintained in a diffusion chamber in syngeneic SL mice induce differentiation. However, when resistant cells were pretreated in vitro with low doses of actinomycin D they became sensitive to inducer in vitro or in vivo. The concentration of actinomycin D effective for this effect did not induce differentiation. The effect of actinomycin D was not due to inhibition of cell growth, since sensitivity was not observed when resistant cells were pretreated with the growth inhibitor 5-fluorodeoxyuridine. When resistant cells were kept in a diffusion chamber in mice injected with low doses of actinomycin D they showed significant differentiation, suggesting that the in vivo effect of actinomycin D is partly attributable to sensitization of the resistant cells to endogenous inducers.


In vitro evaluation of enamel and cementum abrasion after toothbrushing.

Abrasion in human teeth brushed with toothbrush and dentifrice was evaluated quantitatively by SEM. Specimens which included surface enamel and cementum were cut from unerupted wisdom teeth. Controlled brushing was carried out by a brushing machine, with dentifrice or saline, for periods of five and ten minutes. Scratches were counted using SE micrographs. No scratches were observed on the enamel surfaces, due probably to its hardness. The cementum surfaces revealed scratches, the number increasing with the duration of burshing. Brushing with saline was much less abrasive than with dentifrice. It was concluded that damage to the cementum is caused primarily by the dentifrice, brushing per se being a minor factor.


Loss of arch integrity due to interproximal caries.

A simple orthodontic procedure, utilising a fixed appliance, is described. The procedure is adopted to correct a problem commonly met with in conservative dentistry. It enables a correctly contoured restoration to be placed which will prevent the development of further dental problems.


Fatal pneumopathy after cytostatic treatment for leukemia in children.

Two cases of fatal pneumopathy during cytostatic therapy for acute lymphatic leukemia of childhood, are reported with pathoanatomical lung findings and general clinical features. Histology revealed massed atypical epithelial proliferation in the bronchiolar terminal pathways (tumourlets) with multinucleated polymorphic giant cells beside pulmonary fibrosis. As causative factors for pulmonary chages hypersensitivity reactions, direct toxicity, or pharmacologic effects are discussed. Formal pathogenesis is explained by an impairment of endothelial cells in alveolar capillaries followed by permeability disorders and interstitial edema with disturbed perfusion. Disseminated intravasal microthrombi are frequent. Restitution to integrity appears possible only under favorable conditions. If the exsudative turns into the proliferative phase, intraalveolar and interstitial pulmonary fibrosis may develop with atypical epithelial proliferations. The prognosis of cytostatics-induced pneumopathies depends essentially on the time when it is diagnosied.


The accumulation of the base metals (copper, zinc and mercury) in the human body.

Overdramatized, unscientific investigations have contributed to the misconception that the cumulative effects of dental alloys are a serious threat to the clinician and other dental personnel. The reliability of the instrumentation and analytical techniques used for the analyses in this investigation has been well-documented. The following conclusions, therefore, may be drawn from the data: The absolute serum values for all groups involved in the study appear to be within the normal concentration range for the metals tested. Zinc concentrations appear to increase with the age of the individual; however, the values are still within the normal range. Copper and mercury serum-concentrations do not appear to increase with age; however, continued ingestion of foods contaminated with methyl mercury could lead to increased levels of this compound. There is no significant increase in serum copper or zinc in dentists who have been in active practice for twenty years; however, the increases in blood-mercury as measured in this study indicate that occupational exposure may not be as harmful as previously believed. When one considers that only a part of the total concentration is toxic organic mercury, the elevated value after twenty years of exposure appears to be insignificant in terms of danger to the clinician.


Sedation of the autistic patient for dental procedures.

It would be wrong to draw firm conclusions in this paper, because the methodology was highly subjective. However, the authors are of the opinion that certain conclusions can be drawn: Autistic individuals, even those with wildly aberrant behavior, can frequently receive dental treatment in a routine manner, if adequately sedated. Various sedative drugs may be effective. Combinations of drugs may be successful, where individual drugs have failed. The authors found the combination of Nisentil and Phenergan, supplemented with Vistaril when needed, to be especially effective. N2O-O2 analgesia appears to be beneficial, either alone or as an adjunct to other medications.


Von Gierke's disease: report of case.

Von Gierke's disease, or hepatorenal glycogenesis, type I, presents an interesting challenge to the dental practitioner. Showing an incidence of 1/400,000, it is a fairly rare occurrence. It indicates the importance of proper medical consultation in treating these children, and proper dental treatment and preventive programs to alleviate what could be dangerous for these patients.


The general practice residency: its effect on specialization in dentistry.

The federal government has assumed an active role in the effort to increase the proportion of dentists choosing general dental practice as a career instead of specialty practice and has encouraged development and expansion of additional general practice residency training programs for this purpose. This paper reports on career decisions of graduates of one dental school for the past ten years. The findings suggest that general practice residencies may in fact lead to an increasing degree of specialization rather than enhancing long range career interests in general dentistry.