Low concentrations of indomethacin inhibit phospholipase A2 of rabbit polymorphonuclear leukocytes.

Inhibition of prostaglandin synthesis by indomethacin, a drug with anti-inflammatory properties, has been attributed to its action on fatty acid cyclooxygenase. However, prostaglandin synthesis would also be inhibited if precursor fatty acids were not supplied. We find that indomethacin inhibits phospholipase A2 (phosphatide 2-acylhydrolase, EC 3.1.1.4) of rabbit polymorphonuclear leukocytes in dose-dependent fashion. Inhibition is immediate and readily detected at 1 micrometer. The extent of inhibition is the same over a 10-fold range of substrate concentration and over a 500-fold range of enzyme purification. Inhibition is of the noncompetitive type, with an apparent Ki of 12 micrometer. Four other phospholipases A2--from venoms of Russell viper, Crotalus adamanteus, and bee, and from pig pancreas--are unaffected by 50 micrometer indomethacin, which inhibits leukocyte phospholipase A2 by 70%. This inhibition at low concentrations may well be important in the effects of the drug on protaglandin synthesis and inflammatory responses.


[Met5]Enkephalin content in brain regions of rats treated with lithium.

In rats, chronic treatment with lithium elicits a dose-dependent increase in the [Met5]enkephalin content of nucleus caudatus and globus pallidus. A single injection of lithium fails to change the striatal [Met5]enkephalin content. The increase in [Met5]enkephalin caused by chronic lithium is proportional to the serum lithium level. The extent of the increase in striatal [Met5]enkephalin content levels off at a value of about 250% that of untreated rats. This increase has a time latency of 2--3 days and reaches a plateau at 5 days. The increase that was present at 5 days was no longer evident if the treatment was continued for 2 weeks. Lithium also increases striatal [Leu5]enkephalin content by an extent equal to the increase of [Met 5]enkephalin. Based on the characteristics of the lithium-induced increase in [Met6]enkephalin content, it is proposed that lithium may reduce the rate of release of [Met5]enkephalin from the small enkephalinergic neurons that are intrinsic to the striatum; this action may be related to a change in the regulation of striatal neurons.


Antineoplaston A in cancer therapy. (I).

Twenty-one patients with advanced cancer or leukemia were treated with antineoplaston A and followed for up to nine months. Dosage by intravenous, intramuscular, subcutaneous, rectal, intrapleural, intravesical and/or topical administration ranged from 0.6 to 33 U/m2/24 h. Treatment was well tolerated, although side effects included fever of short duration and elevation of platelet and white blood count. In 18 cases some degree of clinical improvement was observed. Complete remission occurred in 4 cases. More than 50% remission occurred in 4 other cases which, along with another 6 cases, are continuing the treatment with high doses of antineoplaston A and show a continuing regression of the tumors although not yet achieving the criteria for complete remission; 2 of these 6 cases seem unlikely to achieve remission. Two patients temporarily discontinued treatment. During treatment, 5 patients expired; in 2 of them, however, was seen significant regression of the neoplastic process. The deaths were not due to cancer or to any toxicity incurred by the treatment.


[Ultrastructure of achromic malignant melanoma of the gingiva. value in differential diagnosis].

The authors report a case of a large oral tumour. On the basis of classical histological and histochemical techniques, the diagnosis was oriented towards an angiosarcoma though it was not possibile to eliminate an achromic melanoma. Ultrastructural studies demonstrated the presence of premelanosomes and established the diagnosis of an achromic malignant melanoma. The clinical interest of this approach isthus emphasised.


[Study of stresses in the fractured mandible in man. Theoretical measurement and verification by extensometric gauges in situ].

The authors study the various possibilities for measuring the stresses which develop within the mandible under the effect of masticatory forces. Several methods are proposed:--calculation with the aid of mathematical models,---the use of extensometric gauges in vitro with the aid of traction machines,--the use of extensometric gauges in vivo. The results obtained with all three methods are in agreement and, in the opinion of the authors, provide experimental evidence of the well-founded nature of Michelet's technique of osteosynthesis.


[A poorly reduced fracture with spontaneous consolidation in good position].

The authors present a case of double mandibular fracture in a partially edentulous patient, which was poorly reduced but nevertheless evolved spontaneously to consolidation in a satisfactory position. They feel that only the influence of muscular forces can explain this fortunate outcome. The technique involving the use of plate and screws is felt to be preferable to osteosynthesis using steel wires in such cases.


[Hyperkinetic syndromes. Therapeutic trials].

The Authors report their therapeutic experiences with RO 5/4023 begun in 1969, on some hyperkinetic syndromes. The casuistry includes six cases of facial spasm, three cases of Huntington disease, three cases of benign essential tremor, one case of Gilles de La Tourette disease. The favourable results of the drug are estimated in percentage that in somecases has reached 70%.


Myelomatosis terminating in acute myelogenic leukaemia.

A case of acute myelogenic leukaemia developing after 7 months treatment with alkylating agents for multiple myeloma is reported. The patients was also given irradiation for an expansive process in the thoracic column. By immunofluorescence staining of the bone marrow cells there was no evidence for production of pathological globulins in the blast cells, while the plasma cells contained IgA, kappa.


Metastatic tumors of the foot.

Four metastatic tumors of the foot, of colonic, renal and humeral origin, are described. They involved three calcanei and two tali. All four patients died within a few months after the appearance of metastasis to the foot. Bony destruction, pain, and swelling can closely resemble the clinical signs and symptoms of osteomyelitis. Diagnostic roentgenograms must be obtained to rule out the possibility of metastatic disease, and biopsies are usually required for accurate diagnosis.


Maintenance of hemoglobin inducibility in somatic cell hybrids of tetraploid (2S) mouse erythroleukemia cells with mouse or human fibroblasts.

It has previously been reported that Friend mouse erythroleukemia (MEL) cells synthesize hemoglobin when exposed to 2% dimethylsulfoxide, and that hybrids between MEL cells and fibroblasts (or other nonerythroid cells) do not synthesize hemoglobin. We have been successful in obtaining hybrids (3/15) between MEL cells and mouse L-cell fibroblasts that maintain hemoglobin inducibility by preserving nonadherent cells after fusion. The proportion of hemoglobin inducible hybrids can be increased (8/11) by using a stable 2S (pseudotetraploid) MEL parent in addition to preserving nonadherent cells after fusion. All hybrids which were nonadherent were hemoglobin inducible, and all hybrids which were adherent were not. Five nonadherent hybrid clones were analyzed from fusions between a stable 2S MEL parent and a human fibroblast (WI-38, VA-2). All these clones were inducible for hemoglobin. It is concluded that gene dosage is effective in increasing the proportion of hemoglobin inducible hybrids, but hybrid morphology is the phenotype characteristic that correlates most closely with expression of hemoglobin inducibility.


[Percutaneous cervical anterolateral cordotomy (author's transl)].

A brief history of percutaneous high cervical anterolateral cordotomy is followed by a review of the anatomy and neurophysiology of the spinothalamic tract. Then a report is presented of the results of 40 percutaneous cordotomies carried out on 32 patients at the Department of Neurosurgery, University of Graz. Operative procedure, indications and advantages of this functional operation are discussed.


[Adenyl cyclase activity of human blood platelets in various blood diseases].

Adenyl cyclase activity was estimated in blood platelets of healthy persons and of patients with myeloleukosis, osteomyelofibrosis and with Glanzmann's thrombasthenia. Six-fold decrease in the adenyl cyclase activity from the platelets was observed in chronic myeloleukosis. The enzymatic activity in platelets was similar to normal level in osteomyelofibrosis and Glanzmann's thrombasthenia.


[Fatal accidents with compressed air diving equipment (author's transl)].

The post-mortem findings of 4 sport divers involved in accidents showed air embolism of the heart as well as 2 subcutaneous emphysemas of shoulder and neck. The lungs were distended and the viscera were hyperaemic. The pleura showed petechiae and small patchy hemorrhages. In microscopic examination foci of alveolar hemorrhages of the lungs and, occasionally, muscosal rupture of small branches of the bronchial tree and of the bronchioli could be determined. The most likely causes for the accidents are discussed and special attention is given to panicking under water.


The cytology of malignant mesothelioma in Western Australia.

The cytology of malignant mesothelioma seen in 12 patients associated with the mining of crocidolite asbestos in Western Australia is described. Two main patterns of mesothelioma were observed: the spindle cell and epithelial varieties. In the more common epithelial variety, five features were found to be of particular value in making a cytologic diagnosis. These include the finding of cell aggregates, multinucleation, the presence of brush-like borders, the close apposition of cell borders, and a characteristic cytoplasm. A diagnosis of malignant mesothelioma may be established by cytologic examination of effusions. The awareness of the possible occurrence of such a primary malignant neoplasm with the features outlined may be helpful in this regard.


An evaluation of cytologic sampling techniques. A comparative study.

False negative cervical cytology is primarily due to errors in sampling. It has been demonstrated that combined ectocervical and endocervical sampling techniques will improve the yield. A prospective study was done to compare ectocervical and combined sampling with a selective technique in which the examiner determines the location of the squamocolumnar junction and chooses the appropriate method. The results demonstrate that combined ectocervical and endocervical sampling significantly increases the number of positive Papanicolaou smears. Selecting which cervices should be samples ectocervically and which need combined sampling does not significantly improve the yield over ectocervical sampling alone. It is the conclusion of this study that both ectocervical and endocervical sampling should routinely be used.


Cytology of non-Hodgkin's malignant lymphomas involving the stomach.

An attempt was made to diagnose cytologically non-Hodgkin's malignant lymphomas (ML) of the stomach on gastric smears in terms of the Kiel classification. This classification represents a more advanced approach for the identification of ML with regard to the cell type specificity, with some functional connotations as compared with previous classifications. The endoscopic brushing cell film studies, when compared with histology of endoscopic biopsies and/or surgical specimens, indicated a high accuracy of cell type identification. Sampling may represent problems in relation to the type of gross lesion. Specific cell types could be recognized in 20 of 25 cases of gastric involvement of ML. Six of nine cases of lymphoplasmacytoid ML revealed diagnostic cells, such as lymphoplasmacytoid cells, plasma cells, lymphocytes, and occasional immunoblasts. Six of seven cases of centrocytic ML had a large number of small cells with indented nuclei, and seven of eight centroblastic-centrocytic ML yielded a mixture of large centroblasts and small centrocytes. In addition to these 24 low-grade ML, one case of unclassifiable high-grade ML was diagnosed. Differential diagnostic problems within ML subtypes and with benign lesions, such as pseudolymphoma of the stomach, as well as malignant tumors and especially diffuse type gastric carcinoma, are taken into consideration.


Syringing as a method of cell dispersal. I. Effect on intermediate and superficial squamous cells.

Mechanical shear in the form of syringing was applied to human gynecologic cytology specimens in an effort to disperse cell clumps. The percentage of single squamous cells achieved with the optimum conditions is generally 70 to 100 per cent. Syringing with a constant pressure device produces a high yield of single squamous cells without the concurrent high cell loss as often observed using enzymatic or chemical procedures. Data presented demonstrate that the slide preparation and clump evaluation procedures used for this study yield reliable and reproducible data. Studies varying stroke number and plunger pressure were completed and conditions for maximum dispersal were established.


Pompe's disease: ultrastructural alterations of muscle tissue in parents.

A histological, histochemical and ultrastructural study of muscle tissue was performed in the parents of a patient affected by a infantile form of acid maltase deficiency (Pompe's disease). In both parents the clinical examination was normal, but serum levels of creatine kinase (CK) and aldolase were high. Histological and histochemical examination of muscle did not reveal any abnormality. Ultrastructural study showed an excess of glycogen granules below the sarcolemmal sheat and between myofibrils, often associated with clusters of mitochondria. There was no glycogen trapped in lysosomal vesicles. The mechanism of glycogen storage in Pompe's disease seems to involve an enzymatic deficiency other than acid maltase.


Koilocytosis in dysplastic and reactive cervical squamous epithelium. An ultrastructural study.

Koilocytosis was studied in eight cases of dysplasia and reactive atypia with conventional transmission electron microscopy. The ultrastructural features were compared to the process of maturation of normal cervical epithelium. Koilocytosis was observed as abnormal karyopyknosis as represented by irregular nuclei, coarse chromatin clumping, the less dense ellipsoid perinuclear zone, and the increased tonofilament bundles in the outer zone of the cytoplasm accentuating the margin of the perinuclear zone of the cells.


Sequential cytologic study of the development of squamous cell carcinoma induced in subcutaneously implanted bronchial autograft of dog.

Squamous cell metaplasias and the development of squamous cell carcinomas caused by carcinogenic polycyclic hydrocarbon exposure of the lumen of grafted dog bronchi were followed by cytology, and were correlated to histologically and ultrastructurally observed changes seen in the biopsy specimens at the same time periods. Cytologic specimens showed a progression from mild atypia of squamous metaplastic cells, to moderate atypia, and to marked atypia before the development of invasive squamous cell carcinoma. Histology obtained by the biopsy specimens revealed findings corresponding to these cytologic changes. In the premalignant phase, squamous dysplasia and carcinoma in situ-like changes were also seen. Ultrastructural findings of the epithelium, such as widened intercellular space, increasing tonofilaments, enlarged nuclei with deep indentations, and prominent nucleoli with microsegregation were characteristic changes in the preneoplastic stages. It was concluded that this method of cytology, reflecting histologic and ultrastructural changes, is a useful experimental tool for the comparative study of premalignant lesions in the human bronchus and their early neoplastic stages.


[Preliminary analysis of intensive treatment of acute lymphoblastic leukemia in children].

The analysis was carried out on 31 children with acute lymphoblastic leukaemias. In 29 of them remissions were obtained conducting later during 3 years intensive maintenance therapy associated with radiotherapy to the central nervous system (according to the method of the Memphis group). Superiority of intensive treatment in relation to more sparing treatment has been demonstrated. Therapeutic failures were observed in children with primarily poor prognosis of leukaemia, especially with blastic hyperleucocytosis. The behavior of serum immunoglobulins and especially infections occurring in children during treatment are discussed.


[Usefulness of beta-glucuronidase activity determination in the differential diagnosis of acute leukemia].

In 95 cases of acute leukemias the cytochemical type was determined according to Löffler's classification and the activity of beta-glucuronidase was determined in blast cells. In the light of these investigations it was demonstrated that determination of the activity of this enzyme may be useful only in the differential diagnosis and classification of certain cases of acute lymphoblastic or undifferentiated-cell leukaemias.


Familial non-Hodgkin lymphoma: histologic diversity and relation to other cancers.

Familial non-Hodgkin lymphoma (NHL) cases were classified according to the histologic criteria (modified) of Rappaport, to determine the extent of morphologic similarities of the tumors. In four families affected members had different tumor histologies that may be observed in an individual patient as the lymphoma progresses. In two families, the affected relatives had tumors of seemingly discordant histology. These tumors may nonetheless be etiologically related as indicated by the pattern of laboratory abnormalities, especially immunologic, in affected as well as unaffected members. The 20 cases had a reversal of the sex ratio (M/F) usually seen in NHL: 0.5 instead of 1.3. Other tumors observed in these families included primary hepatocellular carcinoma, pulmonary adenocarcinoma, Hodgkin disease, and acute lymphocytic leukemia - all of which have been associated with inborn or acquired immunodeficiency states.


Anteroposterior dysplasia indicator: an adjunct to cephalometric differential diagnosis.

1. Cephalograms of 102 children with normal occlusion (Group 1) and 874 children with various malocclusions were analyzed to determine which measurements would produce the highest correlation against the displacement of the molar relationships. 2. Molar displacement was measured directly on the study casts, and an average of the measurements of the right and the left sides was obtained. 3. The malocclusion sample was divided into groups according to molar displacement: 214 neutroclusion cases (Group 2), 624 distoclusion cases (Group 3), and 36 mesioclusion cases (Group 4). 4. The mean value of the anteroposterior dysplasia indicator (APDI) in the normal group was 81.4 degrees, with a standard deviation of 3.79. 5. The APDI reading was obtained by tabulating the facial angle plus or minus the A-B plane angle and plus or minus the palatal plane angle. 6. Among the measurements tested, the APDI was found to show the highest correlation against the molar displacement, with a correlation value of 0.643. 7. The four variable that produced the highest correlation coefficient value--that is, the ANB angle (-0.495), the A-B pland angle (0.566), the "Wits" appraisal (-0.639), and the APDI (0.643)--were subjected to a study of their frequency distribution patterns. High percentage of overlapping of the two extreme groups (distoclusion and mesioclusion groups) were found in the above variables, with the exception of the APDI. 8. A discussion of the differential diagnostic value of the APDI was presented, together with illustrations and various clinical examples.


Localized mucormycosis following intramuscular corticosteroid. Case report and review of the literature.

A case of subcutaneous localized mucormycosis infection which developed following intramuscular (IM) injection of corticosteroid in a patient with leukemia is presented. Aggressive treatment, which included wide local excision, systemic amphotericin-B, and chemotherapy for the leukemia, resulted in eradication of the infection and complete healing of the wound. A review of the literature revealed nine other patients with the localized subcutaneous form of mucormycosis (excluding patients with burns and rhinocerebral types) and six of those nine patients also survived the infection. It is possibly the mildness of the underlying predisposing factors that allows some of these patients to contain the infection at a single site. It is apparent from review of the literature that in subcutaneous localized forms of mucormycosis, the outcome has been generally good. This contrasts sharply with other clinical forms of mucormycosis infections where the underlying predisposing factors are usually severe and any kind of therapeutic approach has been almost always futile. Subcutaneous mucormycosis infection differs clinically and histopathologically from subcutaneous localized entomophthoromycosis which is seen predominantly in tropical countries. An attempt is made to clarify the terminology of these interesting fungi in language that is taxonomically up-to-date and still useful to clinicians.


Soft-tissue changes related to the surgical management of mandibular prognathism.

A series of fifty patients treated surgically for mandibular prognathism has been analyzed statistically to study relative soft- and hard-tissue changes. Changes in the soft tissue of the chin and in the lower lip position relative to the underlying mandibular structures are well related in a nearly 1:1 ratio. Upper lip modifications have been shown to be less well related to mandibular repositioning. The ratio of change of mandibular landmarks to soft-tissue points and their over-all positional change can be helpful in presurgical treatment planning of patients with mandibular prognathism.


The craniofacial skeletal pattern of the South African Negro.

Lateral cephalometric head film measurements on twenty-seven male and twenty-eight female adult craniums and mandibles with excellent occlusions were compared with similar measurements on Caucasoids with excellent occlusions. Among the differences between the two groups is the forward position of the short maxilla relative to the anterior cranial base in the South African Negro. The forward location of point A has the effect of increasing the ANB angle, since the relative position of point B in both groups is much the same. Unlike the American Negro, the labial inclination of the upper incisors in the South African Negro is not pronounced but is similar to the inclination observed in Caucasoids. Because of the large ANB angle, the lower incisors in the S.A. Negro (as in the American Negro) are severely labially inclined. Ramus height in the S.A. Negro is shorter than that of Caucasoids and appears to be related to the steep mandibular plane observed in the former population group.


[Servoventilator and kuhn-system. A device for intermittent manual ventilation (author's transl)].

A modification of the Servo-Ventilator is described: With the help of "Kuhn's System" it is possible to manualy ventilate a patient while for instance searching for a defect in the ventilator or in certain operative situations. The adaptation is simple and cheap and should be easy to implement in every clinic.


Survey of curriculum and instruction: continuing education courses in pain control.

Pain and anxiety control is taught at the continuing education level in a large number of diverse courses. This paper reports the results of a survey of those courses held in 1976. The majority of courses centered on the use of inhalation or intravenous sedation. Relatively few courses were offered on the other aspects of pain and anxiety control. Very little attempt is being made at formally evaluating the competence of participants in these courses. Few courses appear to adequately cover the prevention and management of complications. Suggestions for changes in the teaching of pain and anxiety control at the continuing education level are made based on these findings.Pain and anxiety control encompasses the application of various physical, chemical and psychological modalities in the prevention and treatment of peri-operative patient apprehension and pain. Patient apprehension about dental procedures is felt to influence the seeking of remedial and preventive dental care by a significant portion of the population. Efforts to improve the training of dentists in pain and anxiety control modalities have included several workshops sponsored by the American Dental Society of Anesthesia, the formulation of guidelines for courses at the predoctoral, postdoctoral and continuing education levels, and the establishment of postdoctoral pain control training programs at several dental schools.Recent graduates have been trained in pain control in predoctoral programs which vary widely in content and length. A large number of practitioners seek training in pain control through continuing education courses offered by dental schools, hospitals and a variety of other institutions. This paper reports the results of a survey of these courses and suggests several recommendations based on the findings.


Mycosis fungoides evolving to myelomonocytic leukemia.

Acute myelomonocytic leukemia, a type of leukemic conversion that may be a manifestation of mycosis fungoides, developed in two patients with fairly typical courses of mycosis fungoides. The cases of five other patients with myelogenous leukemia as the terminal event of mycosis fungoides have been reported in the literature. A relationship to therapy could not be established, although all patients had had irradiation or chemotherapy or both.


Intellectual abilities among survivors of childhood leukaemia as a function of CNS irradiation.

Twenty-eight children in remission at least 2 years after completing chemotherapy for acute lymphoblastic leukaemia were assessed on standardised psychological tests. It was found that 7 who never had central nervous system (CNS) irradiation and 9 having prophylactic CNS irradiation at least 6 months after diagnosis tended to perform at average or above levels, while those 10 each having prophylactic CNS irradiation (within 2 months of diagnosis) were generally of lower ability. Within the latter group, 3 children showed serious intellectual impairments, while the group as a whole functioned especially poorly on quantitative tasks and those involving speeded performance with abstract material. General language ability was not affected. Practical and theoretical implantation are discussed.


Personnel safety and foliage residue in an orchard spray program using azinphosmethyl and captan.

Residue levels of azinphosmethyl and captan were determined from blotter paper patches attached to the clothing of personnel participating in an orchard spray program. Average exposure of 1.74 mg/man/hr for azinphosmethyl and 1.94 mg/man/hr for captan were extrapolated from mean residue values obtained from analyzing the patches. Azinphosmethyl residue found on apple and peach foliage had been reached by 69% by the tenth day post-application, while captan residue had been reduced 50% for the same period. There was no evidence of a buildup of either azinphosmethyl or captan on treated foliage as the season progressed.


A recent development in the treatment of severe compound fractures.

The Wagner leg lengthening device has recently been used successfully as an external fixation device in the stabilization of severe compound fractures. Fixation is rigid, yet adjustable, it does not interfere with the fracture site, and it allows clear access to wounds.


Arthroscopy of the knee.

Arthroscopy of the knee is an essential diagnostic aid for difficult knee problems. It is safe and is indicated especially in the problem knee of adolescents, where it is most undesirable to remove a normal cartilage; in litigation cases; in the post-surgery knee problem; in planning surgical procedures; and in surgery on professional sportsmen.


Chronic pain and the psychiatrist.

The contribution of psychiatry to the evaluation and treatment of chronic pain is described. Psychological profiles may predict the outcome of surgery, while the psychiatric interview enhances understanding and may disclose formal psychiatric disorder. The measurement of pain is dependent on factors affecting pain complaint, and the psychiatrist can only accept the patient's experience. The reaction inhibition test and Chapman's Somatic, Anxiety, Depression (SAD) index provide ways of elucidating the functional versus organic dilemma. This is further understood by attention to the concepts of operant pain, the sick role, and illness behaviour. Psychotropic medications, psychotherapy, behaviour therapy, biofeedback, and distractional methods are the tools available to the psychiatrist. The patient's attitude and a combined physical and psychiatric approach are important for successful therapy.


Melanoma of the central nervous system.

The neurological manifestations of melanoma are analysed in this review of 1,500 patients in the Queensland Melanoma Project from 1963 to 1969. Three hundred and fifty patients have died, and 113 were recognized as having central nervous system metastases. The natural history of these metastases was examined, together with the results of a limited number of autopsies. The results of treatment are discussed.


The urinary melanogen cysteinyldopa in melanoma and in suntanning: Australian experience.

Determination of urine cysteinyldopa excretion is the most sensitive chemical test for the detection of melanoma metastases and has been successfully applied during the Scandinavian winter, when sun irradiation is low. The value of this determination, under Australian conditions of greater sun irradiation, has been assessed by comparing the cysteinyldopa excretion of patients with that of normal subjects exposed to sunlight. Cysteinyldopa is an intermediate in the biosynthesis of the red-brown phaeomelanin. Of 20 patients without known secondary melanoma, the cysteinyldopa concentration of "spot" urines ranged from 0 to 190 (mean 48) microgram/ml; of six known to have local metastases, 0 to 80 (mean 19) microgram/ml; and of four known to have extensive metastases 80 to 1350 (mean 330) microgram/ml. The effect of sun irradiation alone was assessed in nine healthy subjects followed one to 11 weeks before and after recorded periods of sun exposure. The cysteinyldopa concentrations of 24-hour urines ranged from 40 to 3100 microgram/ml. Increases occurred three to 10 days following sun exposure and were greatest following multiple small exposures in an individual with "Celtic" complexion. It is concluded that measurement of cysteinyldopa concentration would be of value in the follow-up of melanoma patients in Australia only if patients could be persuaded to live under conditions free of all direct sun-irradiation.


Actual doubling time values of pulmonary metastases from malignant melanoma.

The growth rate of pulmonary metastases was determined in 18 patients with pulmonary metastases from histologically proven malignant melanoma. From chest radiograms 81 metastases were measured 51 consecutive times, and 120 values for doubling time were obtained. metastases with diameters of 15.0 mm or less grew significantly faster (arithmetic mean=24.9 days) than metastases with diameters over 15.0 mm (arithmetic mean=51.0 days). The difference is statistically significant (P less than 0.050). In about one-tenth (9.2%) of all measurements the values for doubling time are considerably lengthened (arithmetic mean=182.2 days). The determination of doubling time values may be considered as a useful parameter in the selection of patients for treatment of pulmonary metastases from malignant melanoma.


Blocking factors against melanoma leucocyte-dependent antibody: relationship to disease activity in melanoma patients.

Previous studies have shown that many melanoma patients have cytotoxic leucocyte-dependent antibody (LDA) which is inhibited by factors in their sera. These factors were shown to be small molecular weight glycoproteins which could also be identified in the supernatants of melanoma cultures, and which were therefore most likely to be melanoma cell surface antigens. The present studies have shown that these blocking factors against melanoma LDA can be detected in patients with primary melanoma, and that the levels of this activity show an inverse correlation with the levels of LDA in the sera of melanoma patients. The appearance of melanoma LDA after surgery for localized melanoma was shown in approximately a third of the patients, and this pattern was shown to result from the disappearance of the LDA blocking activity after surgical removal of the melanoma. Assays were designed specifically to measure the melanoma LDA blocking factors by plasmapheresis. It is not yet known whether the melanoma LDA blocking activity has correlation with tumour growth in melanoma patients. The potential value of measuring this activity to assess response to therapy was shown by studies designed to remove the blocking factors by plasmapheresis. It is not yet known whether the melanoma LDA blocking activity has biological significance in regard to tumour growth, but these studies appear to indicate that measurement of these factors in the sera of melanoma patients may provide a useful in vitro monitor of tumour growth in melanoma patients.


Endolymphatic isotope and BCG in the management of malignant melanoma.

Endolymphatic isotope therapy had such promising early clinical results that the M.R.C. (Medical Research Council) U.K. set up a clinical trial in 1966. This was to compare the effect of endolymphatic isotope therapy with the results of standard methods in the treatment of lower limb malignant melanoma. The interim report had three groups for analysis: Standard Methods (S); Endolymphatic Satisfactory (ES); and Endolymphatic Unsatisfactory (EU). This third group was a subdivision, as a significant number of patients did not have the correct endolymphatic treatment. The five-year survival figures expressed as actuarial percentages were ES=78.8%; S=82.3%; and EU=57.3%. Lymph node recurrence showed a significant difference: ES=2.3%; EU=12%; and S=19%. The conclusions were that endolymphatic isotope therapy was justified in specialized centres where good results could be obtained. Further animal experiments using the VX2 tumour in rabbits indicated that BCG given intracutaneously or intravenously had no therapeutic effect, whereas when applied by intralymphatic injection BCG was successful in treating lymph node metastases. Nineteen patients with poor-prognosis malignant melanoma have received endolymphatic BCG. The clinical results are recorded in this paper and are sufficiently encouraging to warrant its continued use.


Preliminary results of a randomized trial of adjuvant immunotherapy in patients with malignant melanoma who have lymph node metastases.

This study evaluates the effect of adjuvant immunotherapy with BCG alone, or combined with melanoma cell vaccine, on the recurrence and survival rates of patients with metastatic melanoma in the regional lymph nodes who were treated by lymphadenectomy. Patients were prospectively randomized and stratified on the basis of age, sex, site of primary tumour, and clinical estimate of the regional nodes. During the past four years, 134 patients were entered into this trial, and to date, the incidence of recurrence among the two arms mentioned and the control arm is not significantly different; however, patients receiving BCG alone had longer survival than those in either the tumour cell vaccine or control groups. The improved survival in the BCG-only group was found to be due to the fact that patients survived longer with their recurrent disease than the patients in the other two groups. At the present time, these differences do not appear to be significant enough to justify routine adjuvant immunotherapy in patients with melanoma metastatic to regional nodes. Longer follow-up will be necessary to evaluate the role of adjuvant immunotherapy of Stage II melanoma.


Experience with the Melbourne knee prosthesis, based on the first 35 operations over a three-year period.

The Melbourne knee prosthesis is an improved hinge prosthesis. Its component parts are constructed of a chrome cobalt alloy and ultrahigh molecular weight polyethylene. The hinge has a range of flexion of 120 degrees, and while flexed, can rotate 15 degrees in either direction. Over the past three years a total of 45 prostheses have been inserted in patients with chronic degenerative arthritis of the knee joints. This survey covers the first 35 operations. The most gratifying result has been a dramatic relief of pain in 87.5% of patients. There have been few complications, and no prosthesis has had to be removed. There have been no mechanical failures of the prosthesis itself.


Antibiotics in the management of inflammatory lesions of the intervertebral discs in young children.

A review of 35 cases of inflammatory lesions of the intervertebral discs in young children has failed to establish a role for antibiotics in management. There is a tendency to overinvestigate and overtreat this benign, self-limiting malady, for which a period of six weeks of immobilization in a double hip spica is recommended.


Antibiotics in the management of postoperative disc space infections.

The place of antibiotics in the management of postoperative disc space infections is examined on the basis of a review of 14 cases. Whereas the role of antibiotics is clear in acute infections which manifest themselves in the early postoperative period, this is not so for cases which present late with a chronic process. Here, immobilization in a double hip spica is the single therapeutic measure recommended.


Antibiotics in the management of acute haematogenous osteomyelitis and acute spetic arthritis in infancy and childhood.

The introduction of antibiotic therapy has changed the natural history of acute haematogenous osteomyelitis and acute septic arthritis. Early diagnosis and early effective treatment are the means of preventing the devastating sequelae which can occur. Although several different organisms can cause these conditions, the most appropriate antibiotics to exhibit before bacteriological proof of diagnosis is established can be deduced from a study of their historical microbiology. This paper reports such a study and makes recommendations regarding antibiotic treatment.


The bacteriological diagnosis and antibiotic treatment of haematogenous vertebral osteomyelitis in adults.

A review of 49 cases of haematogenous osteomyelitis of the spine has indicated the need for planned investigations to establish a bacteriological diagnosis and appropriate antibiotic therapy. The data suggest that antibiotics may not influence the outcome in patients presenting with a chronic infective process, particularly when this is located in the lumbar region.


Forearm fractures in children.

A prospective survey of over 1,000 forearm fractures in children is presented. Individual fracture patterns are considered and specific complications and methods of treatment are discussed. Conservative treatment produces satisfactory results in the majority of fractures, provided that it is done with care and the patients are adequately followed up.


Secondary malignant melanoma in lymph nodes: incidence, time of occurrence, and mortality.

During a follow-up period of six to 12 years, 15.4% of patients in the Queensland Melanoma Project (Q.M.P.) developed histologically proven secondary deposits in lymph nodes. The incidence rate in males (21%) was twice that in females (11%), but the mortality rate was similar (M., 67%; F., 61%). Thirty-two patients (2%) had positive nodes with no known primary lesion. Metastases developed in males with lesions on the foot (50%), on the thigh (29%), and on the back (22%); and in females with lesions on the lower leg (9%) and thigh (20%). About one-half of the nodes were removed at the time of treatment of the primary growth or within two months. Three-quarters were removed in the first year. However, it was found that tumour could remain dormant for more than eight years. Dormant tumours behaved in a similar aggressive fashion on regrowth as non-dormant secondaries. Nodal metastases were present in 5% of patients at the time of their first presentation with primary melanoma. Elective node dissections were done in 6% of males and 11% of females.


Fracture and retrosternal dislocation of the clavicle.

A case of posterior fracture-dislocation of the sternoclavicular joint is described. This injury was successfully treated by open reduction and internal fixation. This rare injury is discussed and an alternative method of treatment is described.


A ganglion causing the tarsal tunnel syndrome: report of a case.

The tarsal tunnel syndrome is a complex of symptoms affecting the foot produced by compression neuropathy of the posterior tibial nerve on the medial aspect of the ankle, within the fibrous osseous "tunnel" that has the posteromedial aspect of the tibia as its floor and the flexor retinaculum as its roof. Keck first drew attention to this entity in 1962, and was followed by Lam in the same year. Despite sporadic reports following these documentations, the clinical recognition of the syndrome is often delayed. It is still frequently misdiagnosed as acute foot strain or plantar fasciitis at its initial presentation (Kopell and Thompson, 1963; Lam, 1962, 1967). In this paper we report a case of tarsal tunnel syndrome caused by compression of the posterior tibial nerve by a ganglion at the ankle.


Repair of the quadriceps apparatus following patellectomy in recent fractures of the patella: a new technique, with results.

The importance of "double tourniquet" technique in repair of the quadriceps mechanism after total patellectomy in recent fractures of the patella is described and its advantages are discussed. The results following this method of repair in 17 total patellectomies have been studied and discussed.


Arginine methyltransferase activity in chronic erythremic myelosis (Diguglielmo syndrome).

Activity of S-adenosylmethionine-dependent arginine methyltransferase was substantially higher in sonicated bone marrow samples from 6 patients with chronic erythremic myelosis than in bone marrow from 3 patients with untreated pernicious anemia, 2 patients with autoimmune hemolytic anemia, and 4 normal persons. Increased activity of this enzyme may be one of the factors contributing to the pathogenesis fo methylated arginines in histones of erythroblasts from patients with chronic erythremic myelosis.


BCG as active immunotherapy in children with acute lymphoblastic leukemia in longstanding remission: positive effects on remission duration and immunologic parameters.

Currently at the University of Florida, 22/45 children and adolescents are long-term survivors in complete sustained remission of standard chemotherapy regimens and central nervous system prophylaxis. All such therapy was discontinued in these survivors at 36 months after diagnosis and they were given monthly inoculations of BCG of the Tice strain by tine technique. 19/22 of BCG-treated patients remain in remission for 12 to 44 + months after cessation of chemotherapy. 1/22 has suffered relapse. Immunological function tests have shown statistically significant increased lymphocyte responses to PPD in contrast to age-matched controls and normal siblings. A trend to earlier than expected return to normal in other immunological parameters, including absolute lymphocyte counts, intradermal skin tests, phagocytosis indices, PHA transformation, and E-rosette forming cells was also observed, coincident with the BCG treatment. Further study of the role of BCG in acute lymphoblastic leukemia patients after cessation of chemotherapy is encouraged.


Immunological rebound following cessation of chemotherapy in 15 acute lymphoid leukemia patients in complete remission.

The number of blood and bone marrow lymphocytes, the E-rosette forming cells, the Ig-bearing lymphocytes, the serum immunoglobulin levels were evaluated after discontinuation of 36 months of chemotherapy in 15 acute lymphocytic leukemia patients in complete remission. The study provides further information on the immunological rebound during the "off-therapy" period.


Modifications of lectin binding on human leukemic cells after neuraminidase treatment.

Cell surface modifications after vibrio cholerae neuraminidase treatment were investigated using three different tritiated lectins: Concanavalin A, Ricinus sanguineus agglutinin (R.S.A.) and Robinia pseudoacacia lectin. Lectin binding measurements were performed on untreated and enzyme treated cells. The cells used were from chronic and acute leukemic donors. After neuraminidase treatment, a significant increase in the number of receptor sites, from 1 to 3 times, was found in all cases tested and for all three lectins utilized with only one exception. The affinity constant was generally decreased after neuraminidase treatment. The increase in number lectin binding sites, indicating extensive modification of the cell surface, is completely consistant with the known importance of sialic acid in determining immunogenicity.


[Selective treatment of leukemia L1210 with combination of deoxycytidine and lethal doses of cytosine arabinoside].

Oral administration of deoxycytidine simultaneously with intraperitoneal injections of toxic doses of cytosine arabinosidetomice with advanced L1210 leukemia diminished the toxic effects preventing drug death of these mice. They developed a marked antitumor effect. The mean survival time of these mice was considerably extended as compared to that of untreated animals or those given one of these drugs alone. At the optimum schedule of treatment about 23% of the mice survived over 60 days. Deoxycytidine protection reduced the antileukemic effect of cytosine arabinoside administered in nontoxic doses. The deoxycytidine plus cytosine arabinose combination was ineffective in the treatment of transplantable myeloid leukemia in mice.


Hypergranular promyelocytic leukemia (APL): cytogenetic and ultrastructural specificity.

Cytogenetic and ultrastructural findings were important diagnostic indicators of hypergranular promyelocytic leukemia (APL) in a patient whose bone marrow morphology appeared, by light microscopy, to be similar to that in acute myeloblastic leukemia (AML) with maturation. Peripheral blood smears and bone marrow specimens examined by light microscopy showed few cells with the numerous coarse, azurophilic granules typical of APL. Cytogenetic analyses, with several banding techniques, of cells from bone marrow and unstimulated peripheral blood revealed the 15;17 translocation, which has been observed only in APL. A reinterpretation of the reciprocal translocation, based on R banding, suggests that the breakpoints are distal to q24 in No. 15 and at or near the junction of q21 and q22 in No. 17. In addition, the patient had disseminated intravascular coagulation. The characteristic morphology of granules seen in APL was observed in this case only when transmission electron microscopy was used, since the granules were quite small. Since treatment for AML differs from that for APL, identification of the 15;17 translocation and ultrastructural evidence of granules represent valuable diagnostic aids for APL.


Cellular maturation in human preleukemia.

Bone marrow cells from three preleukemic patients with prominent marrow karyotypic abnormalities were studied in liquid culture to determine if the neoplastic clones were capable of maturation. Parallel cytogenetic and cytologic studies were performed in sequentially harvested bone marrow cultures. Maturation, albeit delayed, occurred in cultures from all three patients. By 14 days of culture in vitro, morphologic, cytochemical, and functional evidence of maturation was observed in about 70% of the cells. By day 21, 85% of the cells were mature by these criteria. All but 2 of 249 metaphases from the cultured cells contained the cytogenetic abnormality of the neoplastic clone. We conclude that some preleukemic cells identified by a chromosomal abnormality can mature in vitro. Preleukemia may be viewed as a syndrome of "early leukemia" in which the neoplastic clone is established and manifested functionally as ineffective hematopoiesis. Hematopoietic cell differentiation becomes progressively abnormal with termination in the nearly complete maturational block characteristic of acute myelogenous leukemia.


Subpulmonary pneumothorax.

Seven cases of subpulmonary pneumothorax are presented: four due to penetrating injury, two to blunt trauma and one to osteosarcoma metastasis. The typical and diagnostic appearance is a basal band of radiolucency bounded above by the thin hair-line of visceral pleura paralleling the dome of the hemi-diaphragm. When partially clotted blood is also present, the appearance becomes less typical and has to be differentiated from traumatic diaphragmatic herniation of bowel and from traumatic pneumatocoele by barium studies and by decubitus radiographs respectively. It is the bridge-like disposition of the pleural cavity between the dome of the hemi-diaphragm and the hollowed concavity of the lung base which allows pneumothorax to collect in it. It is rarely seen because blebs and bullae which are the commonest causes of pneumothorax are most often located in the upper zones.


Bone-marrow relapse in acute lymphoblastic leukaemia in childhood.

The outcome after bone-marrow relapse was assessed in 53 children with acute lymphoblastic leukaemia (ALL). Twenty-five out of 37 children (67%) whose first remission ended in relapse during treatment (group A) achieved a second remission, as did 15 out of 16 (94%) who relapsed after treatment had been stopped (group B). Nevertheless, the median duration of second remission was only 12 weeks in group A and 35 weeks in group B. The median survival from time of relapse was 32 weeks in group A and 75 weeks in group B. It is concluded that marrow relapse is equally serious whether it occurs during treatment or after treatment has been stopped, and that most children with ALL have a single chance of cure at the time of diagnosis.


I and i antigens on normal and leukemic leukocytes.

Human leukocyte I and i antigens were quantitated using 125I labelled purified antibodies. Binding of these antibodies to leukocytes was dependent on reduced temperature. No significant difference in antigen content was observed between normal and leukemic myeloid leukocytes. B lymphocytes bound much greater amounts of both I and i antibodies than did T lymphocytes. Neoplastic lymphoid cells bound widely divergent amounts of both antibodies with chronic lymphocytic leukemia and lymphosarcoma cell leukemia cells binding much decreased amounts compared to normal lymphocytes. Cells from patients with hairy cell leukemia bound very large quantities of these antibodies in a cold dependent fashion. These elevated levels of binding were not due to nonspecific binding of IgM.


Immunologic dysfunction in the myeloproliferative disorders.

Forty patients with various types of myeloproliferative disorders were evaluated immunologically. Serum immunoglobulin levels were within the normal range in most patients and no monoclonal gammopathies were detected. Serum C'3 levels were decreased in 19 of 40 (48%) patients. The response of peripheral blood lymphocytes to phytohemagglutinin was decreased in 26 of 40 (65%) and to pokeweed mitogen in 18 of 28 (64%) patients studied. Lymphocytes from patients with polycythemia vera were least affected. Unstimulated lymphocytes from some patients demonstrated markedly increased thymidine uptake activity. Despite the diminished mitogenic response, only 2 of 33 patients (6%) were anergic by intradermal skin testing. There was no association between depressed lymphocyte response and recent chemotherapy except in chronic myelogenous leukemia where 6 of 8 patients were receiving cytotoxic therapy when studied. These observations suggest that most of our patients with myeloproliferative disorders have abnormal cellular responses in vitro, but that delayed hypersensitivity and humoral responses are minimally affected.


Disseminated BCG disease associated with immunotherapy by scarification in acute leukemia.

Disseminated BCG infection developed in a patient with acute leukemia receiving BCG immunotherapy by scarification. Predisposing factors included the underlying malignancy, intensive chemotherapy, and continuous high-dose corticosteroids. The scarification technique is safe; however, physicians should be alert to this syndrome as a cause of fever of unknown origin in cancer patients receiving BCG immunotherapy.


Effects of ultraviolet light on nude mice: cutaneous carcinogenesis and possible leukemogenesis.

Squamous cell carcinomas were induced by ultraviolet irradiation in the skin of all T-cell deficient nude mice rendered sufficiently long-lived by reconstitution with syngeneic splenic or thymic cells. All homozygous hairless mice similarly exposed developed squamous cell carcinomas. Striking granulocytic proliferation was provoked in one hairless and in five reconstituted nude mice; two of the latter were interpreted as having true granulocytic leukemia.


Central nervous system involvement at presentation in the chronic phase of chronic myelogenous leukemia in childhood.

With the advent of more effective chemotherapy an increasing incidence of central nervous system involvement in acute lymphocyte (ALL) and myelocytic leukemias (AML) and chronic myelocytic leukemia (CML) in blast crisis has become evident. Meningeal involvement in the chronic phase of CML is rare. We report two children whose initial presentation of Ph1 CML was in the central nervous system as documented by cytocentrifugation. Aggressive combination chemotherapy and cranial irradiation has resulted in prolonged survival without blastic transformation or further meningeal disease. An approach to children with CML is suggested.


Seizures following intrathecal cytosine arabinoside in young children with acute lymphoblastic leukemia.

Two young children (3 1/2 years and 19 months) developed seizures within 24 hours of receiving intrathecal cytosine arabinoside. Both had previously received intrathecal cytosine and methotrexate as well as cranial irradiation without untoward effect. Possible mechanisms of causation are discussed and caution is stressed for use of intrathecal cytosine arabinoside in young children.


The changing survivorship of white and black children with leukemia.

A study was conducted in metropolitan Baltimore to examine changes in survival of white and black children with acute leukemia from 1960 through 1975. Two-hundred eighty-seven cases were identified, of which 77% were acute lymphocytic leukemia (ALL). Eighty-three percent of all cases occurred in white children. In white children with ALL, two-year survival rates increased from 32% in 1960--64 to 47% in 1965--69, and to 79% in 1970--75 (p less than .005). In the small sample of black children with ALL, two-year survival rates increased from 25% in 1960--64 to 59% in 1965--69 (p less than .01), with no further increase in 1970--75. For acute nonlymphocytic leukemia (ANLL), survivorship was analyzed in white children, among whom one-year survival rates increased from 42% in 1965--69 to 71% in 1970--75 (p less than .005). The increasingly better survival over time of white children with acute leukemia probably reflects the increasing efficacy of new therapeutic approaches.


Actual volume doubling time values for pulmonary metastases from soft tissue sarcomas.

Doubling time values of pulmonary metastases from soft tissue sarcomas were measured. Sixty metastases from 24 patients were measured 79 consecutive times, and, the values for 116 doubling times were calculated. Small volume metastases grew significantly faster (arithmetic mean 29.7 days) than large metastases (arithmetic mean 43.4 days). An assessment with comparative data obtained previously by measuring the doubling time values of pulmonary metastases from osteogenic sarcoma revealed similar growth characteristics. The possible involvment of identical control mechanisms operating in the growth process of pulmonary metastases in both soft tissues and osteogenic sarcomas are discussed.


Effects of glucocorticoids on the interaction of lymphoblastoid cells with human endothelial cells in vitro.

The adhesive characteristics of cultured acute lymphocytic leukemia cells (CCRF-CEM), lymphoma cells (Raji), and freshly isolated acute lymphocytic leukemia cells to human cultured endothelial cells were studied. An assay system was used whereby these neoplastic cells were allowed to interact with endothelial cells while being continuously agitated on a rocking platform. All cell lines adhered significantly to the endothelium monolayers. This process appeared not to be dependent upon intact microtubular or microfilament function. Likewise, removing surface sialic acid from either cell type did not alter this process. In contrast incubating the endothelial cells for 24 or 48 hr with dexamethasone decreased adhesiveness of either CCRF-CEM or Raji cells to the endothelial cells by approximately 40%. Incubating these cells with hydrocortisone instead of dexamethasone for 48 hr was equally as effective in altering the endothelial cell adhesiveness. The decreased adhesiveness could be blocked by cycloheximide, indicating that this altered adhesiveness of the endothelial cells involves protein synthesis, presumably of a surface protein. We suggest that this assay system may provide a means to evaluate other agents that can alter the surface characteristics of endothelial cells, which may have important implications in various disease states such as inflammation, thrombogenesis, and metastatic disease.


Two cases of unusual Type I glycogenosis.

Two patients with  apparent clinical manifestations of glycogen storage disease were described. The curves obtained upon glucose and adrenalin tolerance tests were indicative of glycogen storage disease Type I. Liver biopsies showed the increased glycogen concentration; however, the activities of the enzymes involved in glycogen metabolism, including glucose-6-phosphatase activity, were within normal limits or even slightly enhanced. On the basis of the biochemical data, Type Ib glycogenosis was diagnosed. The analytical ultracentrifugation studies of serum lipoproteins of those patients showed that concentration of very low density lipoproteins was considerably increased.


Inability to demonstrate lytic antibodies to autologous leukaemia cells in the sera from remission patients with acute myelogenous leukaemia treated with active specific immunotherapy.

The sera from seven patients with acute myelogenous leukaemia (AML) who had achieved a clinical remission and who were being maintained by weekly immunotherapy using irradiated allogeneic AML cells and BCG, were examined for the presence of antibodies which were lytic to autologous AML cells using either a complement- or cell-dependent assay. The AML cells had been stored at --179 degrees C and put into a short-term tissue culture prior to testing. At no time during the period of remission or relapse could cytotoxic activity to the autologous cells be detected, although all of the sera had lytic antibodies for some allogenic leukaemia cells. We concluded that the patients were capable of raising lytic antibodies to histocompatibility antigens but did not raise comparable lytic antibodies directed against a leukaemia-specific membrane antigen.


Chronic granulocytic leukemia cutis treated with hydroxyurea. Report of a case.

The clinical course of a patient with chronic granulocytic leukemia cutis associated with myeloid metaplasia is described. Cutaneous manifestations of leukemia appeared only at the sites of bone marrow aspiration and vena puncture. Radiotherapy to both spleen and skin and chemotherapy with busulfan failed to control spreading cutaneous lesions. Treatment with hydroxyurea was followed by a marked reduction in spleen size, a decrease in white cell count and healing of the skin lesions.


[Clinical pantographic studies on "immediate side shift"].

The immediate side shift was pantographically recorded, photographed and measured in 32 volunteers with mostly complete dentures. 28 showed initial Bennett movement up to 0.4 mm under tooth contact. Values of between 0.4 and 1.5 mm were demonstrable in only 4 cases. Comparing these investigations in 10 volunteers with and without central supporting peg a clear decrease in measurements could usually be demonstrated.


[Thermic behavior of dental enamel, dentin and selected dental materials].

The linear coefficient of expansion of enamel, dentin as well as selected dental working materials is estimated by means of holographic-interferometric measurements. A good correlation was found between hard dental texture and a phosphate glass envisaged for use with lasers. The possible effects of the greatly increased coefficient of expansion of tested composites is discussed.


[Bending resistance of composites after storage in water from 1 day to 3 months].

The resistance to bending of paste-paste composites decreases with one exception after prolonged storage in water. The UV-hardened artificial filling materials show no uniform picture in this respect. The bending module of three paste-paste composites is at its peak after 24 hours with values of 40 to 50 kN/mm2, and then drops to 1/3 of this value. The value of the bending module of photopolymerising composites lies considerably lower-between 4 and 13 kN/mm2.


[Resistance to pressure of amalgam relative to the pressure of plugging and the alloy-mercury ratio].

The resistance to pressure was tested in 320 Amalgam samples of alloy-mercury in relations of 4:3, 5:5, 5:6 and 5:7 under packing pressures of 2, 5, 10 and 15 N/mm2. These tests were made with a commonly-used and a copper-rich alloy. Very dry mixtures, which condense under low packing pressures, show low pressure resistance.


[Individual differences in the marginal periodontium of crowned and non-crowned topographically identical teeth].

A comparison was made on 191 crowned teeth in 125 patients altogether with removable partial replacements after average wear of 4.8 years with the corresponding number of contralateral uncrowned teeth. It could be shown that there was no significant difference between crowned and uncrowned teeth in respect of periodontal changes (loosening and deepening of pockets of pockets, periodontal diagnosis). Findings in crowned teeth had a frequent tendency to worsen.


[Comparative studies on 4 methods for the measurement of the sagittal position of the mandible in the edentulous patient with special reference to "functional relation"].

Four known registration procedures (Gerber, Schreinemakers, Fehr and adduction point) were used to determine repeatedly the mandibular positions on 24 edentulous patients. The sagittal positions of the mandible obtained as well as the reproducibility of the method was tested. The sagittal difference was of the order of +/- 0.5 mm. The reproducibility of relationship determinations depends on several factors, which are described. The closely approximating results of 384 relationship determinations with 768 measurements point to the fact that a slight scatter depends mainly on the experience of the attendant, who is responsible for a suitable of relationship determination.


Cranial computerized tomography in children with lymphoid malignancy and seizures.

Focal and generalized seizures occurred in 4 patients with acute lymphoblastic leukemia and non-Hodgkin-lymphoma. The etiology of the neurological complications could be established by cranial computerized tomography (CT): i.e., 1. localized metastasis with calcification and 2. acute intracerebral hemorrhage during induction therapy in two patients with malignant lymphomas; 3. diffuse cerebral infiltration with blast cells and 4. cerebral atrophy in two children with acute lymphoblastic leukemia who were in relapse. Accurate diagnosis of cerebral complications in hemoblastoses is essential for appropriate therapy and CT may lead to more effective treatment in patients with lymphoid malignancy and seizures.


Serum lysozyme activity in children with acute leukemia.

Serum lysozyme activity was measured in samples from children with acute leukemia, malignant tumours, and in normal children. All children with acute lymphatic leukemia (ALL) had significantly reduced levels of lysozyme at diagnosis, and none of the children fell within the normal range. Children with ALL in complete remission had lysozyme levels comparable to normal chidren, while children with ALL in relapse also had pathological low levels. Children with ALL in remission and off therapy also had normal levels of lysozyme. Children with acute myelogenous leukemia had normal lysozyme levels, while children with monomyelocytic leukemia had substantially elevated lysozyme levels before treatment. Determination of serum lysozyme activity in children with acute leukemia is of value both for diagnosis and for evaluating the effect of therapy.


Intramembranous particles in erythrocyte, reticulocyte and erythroblastic leukemic cells of the rat: a model system for erythrocyte maturation.

The density and size distribution of intramembranous particles (IMP) were determined for cells of the erythroid series. The number and size of IMP were measured on both fracture faces of erythroblastic leukemia cells, phenylhydrazine-induced reticulocytes and mature erythrocytes. We found that the number of IMP adhering to the protoplasmic fracture face of the plasma membrane increased with increasing maturation, while the number of particles adhering to the external fracture face did not correlate with maturational stage. In general, the mean size of particles adhering to both fracture faces decreased with increasing maturation after the erythroblastic stage. We interpret these results to mean that the IMP seen are derived from more than one macromolecular species and that they are distributed asymmetrically in the plasma membrane.


Production of mesenchymal tumors in nude mice by Ph1 negative fibroblasts obtained from a Ph 1 positive CML patient: a preliminary report.

An experimental model system is presented for the investigation in humans of the role of hematopoietic stromal elements in the regulation of hematopoiesis as well as in the pathogenesis of myelofibrosis in myeloproliferative disorders. The model is based on the simultaneous application of three experimental techniques: (1) growth of bone-marrow derived fibroblastic colonies in vitro, (2) cytogenetic demonstration of marker chromosomes associated with hematopoietic malignancies, and (3) the transplantation of isolated stromal elements into athymic (nude) mice. Using this model, we describe the induction of mesenchymal tumors in nude mice by Ph1 negative fibroblasts obtained from the bone marrow of a patient with a Ph1 positive chronic myelogenous leukemia. Mesenchymal tumors also were induced in nude mice with bone marrow-derived fibroblasts from a patient with aplastic anemia, who was successfully treated with bone marrow transplantation, and from a normal human volunteer. Morphologic, cytogenetic and electron microscopic studies of bone marrow mesenchymal elements in culture and of tumors induced in nude mice from the CML patient indicate the cells composing the tumor are of human origin and are negative for the Ph1 chromosome. The results provide the first in vivo morphological and cytogenetic support using human materials, of the hypothesized relationship of progenitors of in vitro fibroblastic colonies to marrow stromal elements.


Enhancing effect of thoracotomy on tumor growth in rats.

To indicate the influence of operative stress on tumor growth, thoracotomy and/or laparotomy were performed 48 hr after intraperitoneal or intravenous inoculation of Sato lung cancer into Donryu rats. Survival period, number of metastatic nodules on the surface of the lungs, and the percentage-area of metastases in the frontal section through pulmonary hilus were examined. By thoracotomy and laparothoracotomy the survival period of the tumor-inoculated rats was reduced significantly compared with that of the control but difference between these two test groups was not significant. Also there was no significant difference between the laparotomy group and the control. The results obtained in the number and percentage-area of metastatic nodules were quite similar to that observed in the survival period. Correlation between the number and the percentage-area of metastatic nodules was highly significant. The meaning of the stress of thoracotomy in cancer treatment is discussed.


Necrotizing enterocolitis in acute leukemia: radiographic findings.

Acute gangrenous appendicitis or right lower quadrant necrotizing enterocolitis occurs with a high incidence in patients undergoing treatment for acute leukemia. In a series of 81 fully documented cases with complete charts and follow-up we identified seven surgically or pathologically proved cases of this syndrome. Plain radiographs of the abdomen were available in five of the seven cases, and a barium enema was performed on one. In three of the five cases the radiographic examination suggested or confirmed the nature of the right lower quadrant syndrome. Two of the seven patients were sucessfully treated by appropriate surgery. The radiographic findings in this series are reviewed and re-emphasized since an accurate diagnosis becomes important in appropriate management of this formerly uniformly fatal complication of acute leukemia and/or its therapy.


Serum lysozyme activity in some myeloproliferative diseases.

Serum lysozyme activity has been determined in patients suffering from myeloproliferative diseases, chronic myelogenous leukaemia (CML), acute myelogenous leukaemia (AML), chronic lymphatic leukaemia (CLL) and pancytopenia (P). Lysozyme activity was tested in undiluted and tenfold diluted sera. Increased lysozyme activity was found in patients with CML and CLI, whereas there was no change in patients with AML and P. Dilution of sera enhanced lysozyme activity. These data may indicate the presence of inhibitor in the sera tested. The diagnostic significance of the presented findings is discussed.


[Perthes disease after successfully treated acute juvenile lymphoblastic leukemia].

The manifestation of Perthes disease after succesfully treated lymphoblastic leukemia is extremely rare. At the first signs of a femoral head necrosis--sonsidering the basic disease--and after cortisone treatment one has to think of a possible femoral head necrosis. It has been observed by several authors after long-term cortison therapy. The case of a 7 year old boy with Perthes disease after acute lymphatic leukemia is demonstrated. After treatment with chemotherapy, cortisone and radiation of the head he was free of pain for 2 years, then the Perthes disease became manifest with a deformed femural head. It could be cured but operation is necessary now or at the latest after termination of growth. In the case there seems to be no connexion between cortisone treatment and the manifestation of Perthes disease. It is more probable that this developed independently of the basic disease and its successful treatment because of the unilateral affection of the hip joint and the interval between treatment of leukemia and manifestion of the first symptoms of Perthes disease.


[McArdle's disease--description based on three own observations (author's transl)].

The paper reports on three observations made by the authors of McArdle's Disease. Characteristic symptoms are a premature tiring of the musculature and painful muscle contractions; in the late stage of the disease, mild muscle atrophy can also occur. The ischemia test is is pathologic. Myoglobinuria often occurs after major strain. Studies by light microscope and the electron-microscope result in an increased glycogen deposit in the muscle fiber. The diagnosis is verfied by the histochemical and biochemical proof of muscle phosphorylase deficiency. Routine histologic investigation of muscle biopsy is not sufficient to identify the disease. Despite the established enzyme defect and the resulting impairment of anerobic energy availability, the genesis of the disease or syndrome has not yet been fully clarified.


Reciprocal translocation and the Philadelphia chromosome.

We examined metaphases from three patients with chronic myeloid leukaemia and a typical Philadelphia chromosome with one chromosome 9 as the recipient to determine whether the 9q+22q- translocation is reciprocal. Good quality G-banded photographs of the chromosomes concerned were subjected to light absorption density analysis. This provided enlarged tracings corresponding to the relevant chromosome regions and so facilitated accurate measurement. This technique has unambiguously shown that the typical Philadelphia chromosome results from a reciprocal translocation and that probably no material is gained or lost in the exchange. Furthermorein a total of six patients for whom sequential G and C banding was performed, the chromosome 9 with the largest block of centromeric heterochromatin received the translocated material. We offer tentative explanations for this curious observation.


15/17 translocation in acute promyelocytic leukaemia.

A translocation between a chromosome 15 and a chromosome 17 was found in the bone marrow of a 14-year-old boy who had clinical and laboratory symptoms of acute promyelocytic leukemia (APL). As far as we know, this is the sixth case of APL with 15/17 translocation to be reported in the literature. This observation gives further support to the hypothesis that there is an association between this chromosomal rearrangement and APL.


Servo control of end-tidal CO2 in paralyzed animals.

We are reporting an electronic circuit which uses the peak end-tidal CO2 signal from a rapid infrared CO2 analyzer to vary the motor rate of a fixed volume respirator. It contains variable gain and a lag compensation network which permits critical damping to prevent oscillation. The CO2 analyzer, circuitry, and respirator are connected in a closed-loop servo system that allows automatic control of the CO2 level. The system's gain and performance are such that it can accommodate large changes of CO2 return to the lungs with no more than +/- 0.5 Torr carbon dioxide pressure (PCO2) error signal. It has proved useful in experiments on neural respiratory control in paralyzed animals where it is desired to keep PCO2 constant despite changes in cardiac output and venous and CO2 return to the lungs, and to monitor the approximate magnitude of these changes.


The microscopic pattern of tetracycline fluorescence in the cementum of human teeth.

Ultraviolet microscopy of longitudinal non-decalcified sections revealed fluorescence characteristic of in vivo tetracycline deposition in the cementum of 55 out of 378 human permanent teeth. Patterns of fluorescence could be related to various stages in root development and to pathological events, as well as to the approximate duration of drug intake. Cementum lines formed during apposition of primary root dentin were associated with dentin bands and met the latter at the cemento-dentinal junction: other lines corresponded to incremental cementum apposition after completion of the root. Label was also visualized in localized areas of cementum hyperplasia and in repaired resorption lacunae. Discontinuities in broad fluorescent lines at or near the cementum surface were related to lack of connective tissue attachment when drug exposure occurred, or with subsequent root caries. Observations suggest that typical short, single periods of antibiotic therapy are recorded in the cementum, although marginally or close to the limit of resolution in some cases. Longer, chronic administration or multiple short regimens closely spaced in time are clearly registered. Study of these patterns may be useful in clinical periodontal research.


[Parameters of the cellular cyle during odontogenesis in mice].

Autoradiographic methods were used to analyze cell kinetics of mouse tooth germs during days 11, 14 and 16 of gestation. Cell cycle determination estimated from the labeled metaphases curves showed a lengthening of the cell cycle time during development, resulting from lengthening of G1 and S phases. These changes were also function of the histological localization of the analyzed cells.


An investigation of the effects of mellitic acid on hydroxyapatite.

The effects produced on the solubility and crystal growth of hydroxyapatite by the condensed phosphates and the diphosphonates are essentially physicochemical in nature. Other poly-anions, may, on this same basis, produce similar effects. Mellitic acid (benzene hexacarboxylic acid), in dilute solution, was taken up by hydroxyapatite in the presence of excess phosphate and was not significantly displaced by it. Mellitic acid treatment of hydroxyapatite inhibited its ability to "seed" metastable solutions of calcium phosphate. Mellitic acid, which has already been shown to be an effective inhibitor of dental calculus in experimental animals may also have some other properties that could be of advantage to its use in humans.


Human salivary protein interaction with fluoridated synthetic hydroxyapatite.

Adsorption of human salivary protein on synthetic hydroxyapatite after fluoridation of the mineral phase was tested using an experimental system previously described. The salivary protein adsorption on fluoridated apatite was considerably decreased compared to the adsorption obtained with untreated hydroxyapatite. The calcium-precipitable human salivary glycoprotein still seemed to be selectively adsorbed. Liberation of fluoride under the effect of the salivary proteins was also observed. Fluoridation of enamel may decrease pellicle formation with competitive adsorption effect between salivary proteins and fluoride.


[Glycoproteins and proteoglycans in the predentin and dentin matrix in the rat: an ultrastructural study].

The ultrastructural distribution of the protein-polysaccharides was studied in the predentinal and dentinal matrices of the rat. Used for the indentification of the glycoproteins, the chromic-phosphotungstic acid mixture (Rambourt, 1967) weakly contrasted the predentine, underlined the mineralization front and impregnated the dentinal matrix. Alcian blue (Goldberg et al., 1977) as well as bismuth nitrate (Serafini-Fracassini and Smith, 1966), cationic stains for the proteoglycans, produced a strong contrast in the predentine, whereas in the dentine, which appeared clear, only 100 to 150 A granules associated with the periodic collagen striations were stained. This inverse variation between non collagenous proteoglycans and glycoproteins is discussed in relation to the mineralization process.


Hemin control of heme biosynthesis in mouse Friend virus-transformed erythroleukemia cells in culture.

Hemin treatment of mouse Friend virus-transformed cells in cultured caused a dose-dependent increase in hemoglobin synthesis. By the addition of radioactively labeled hemin and by the analysis of the radioactive heme in hemoglobin, only 60 to 70% of heme in the newly synthesized hemoglobin was accounted for by the exogenously added hemin. In keeping with this finding, hemin treatment increased the activity of two enzymes in the heme biosynthetic activity, i.e. delta-aminolevulinate (ALA) dehydratase and uroporphyrinogen-I (URO) synthase in these cells. Incorporation of [2(-14C)]glycine, [14C]ALA, and 59Fe into heme was also significantly increased in the cells treated with hemin, suggesting that essentially all enzyme activities in the heme biosynethetic pathway were increased after hemin treatment. These results indicate that heme in the newly synthesized hemoglobin in hemin-treated Friend cells derives both from hemin added to the culture and from heme synthesized intracellularly. In addition, these results suggest that the stimulation of heme biosynthesis by hemin in Friend virus-transformed cells is in contrast to the hemin repression of heme biosynthesis in liver cells.


ATP depletion, a possible role in the pathogenesis of hyperuricemia in glycogen storage disease type I.

Other investigators have shown that fructose infusion in normal man and rats acutely depletes hepatic ATP and P(i) and increases the rate of uric acid formation by the degradation of preformed nucleotides. We postulated that a similar mechanism of ATP depletion might be present in patients with glucose-6-phosphatase deficiency (GSD-I) as a result of ATP consumption during glycogenolysis and resulting excess glycolysis. The postulate was tested by measurement of: (a) hepatic content of ATP, glycogen, phosphorylated sugars, and phosphorylase activities before and after increasing glycolysis by glucagon infusion and (b) plasma urate levels and urate excretion before and after therapy designed to maintain blood glucose levels above 70 mg/dl and thus prevent excess glycogenolysis and glycolysis. Glucagon infusion in seven patients with GSD-I caused a decrease in hepatic ATP from 2.25 +/- 0.09 to 0.73 +/- 0.06 mumol/g liver (P <0.01), within 5 min, persisting in one patient to 20 min (1.3 mumol/g). Three patients with GSD other than GSD-I (controls), and 10 normal rats, showed no change in ATP levels after glucagon infusion. Glucagon caused an increase in hepatic phosphorylase activity from 163 +/- 21 to 311 +/- 17 mumol/min per g protein (P <0.01), and a decrease in glycogen content from 8.96 +/- 0.51 to 6.68 +/- 0.38% weight (P <0.01). Hepatic content of phosphorylated hexoses measured in two patients, showed the following mean increases in response to glucagon; glucose-6-phosphate (from 0.25 to 0.98 mumol/g liver), fructose-6-phosphate (from 0.17 to 0.45 mumol/g liver), and fructose-1,6-diphosphate (from 0.09 to 1.28 mumol/g) within 5 min. These changes, except for glucose-6-phosphate, returned toward preinfusion levels within 20 min. Treatment consisted of continuous intragastric feedings of a high glucose dietary mixture. Such treatment increased blood glucose from a mean level of 62 (range 28-96) to 86 (range 71-143) mg/dl (P <0.02), decreased plasma glucagon from a mean of 190 (range 171-208) to 56 (range 30-70) pg/ml (P <0.01), but caused no significant change in insulin levels. Urate output measured in three patients showed an initial increase, coinciding with a decrease in plasma lactate and triglyceride levels, then decreased to normal within 3 days after treatment. Normalization of urate excretion was associated with normalization of serum uric acid. We suggest that the maintenance of blood glucose levels above 70 mg/dl is effective in reducing serum urate levels and that transient and recurrent depletion of hepatic ATP due to glycogenolysis is contributory in the genesis of hyperuricemia in untreated patients with GSD-I.


Gingivo-periodontal manifestations in chronic benign neutropenia.

A case of chronic benign neutropenia in a 7-year-old Caucasian male is reported. The predominant clinical symptoms were persistent gingivitis and periodontitis. The clinical, hematological, oral radiographical, histological, and therapeutical features of this uncommon disease are discussed.


Open-field and avoidance behavior after neostriatal lesions in male and female rats.

The behavioral effects of lesions of the anterodorsal or posteroventral parts of the caudate-putamen were studied in adult male and femle rats that were gonadectomized or left untreated prior to brain surgery. Anterodorsal (ADC) lesions consistently impaired acquistion of one-way avoidance behavior and tended to interfere with the development of a two-way avoidance response; comparable effects were observed in gonadectomized and intact animals of both sexes. By contrast, ADC lesions increased activity in the open field only in intact females and increased rearing only in ovariectomized females. Posteroventral caudate (PVC) lesions caused transient aphagia and adipsia in both sexes but did not consistently affect open-field activity or the acquistion of one-way avoidance responses by either sex. These lesions profoundly impaired acquistion of shuttle box avoidance responses by intact males. By contrast, castrated males and intact and ovariectomized females with PVC lesions avoided normally in the shuttle box. The present results suggest that localization of behavioral functions within the striatum differs with the sex of the subject, in part because of activational effects of gonadal hormones.


Quality assurance in a neighborhood health center: dental services.

A method for assessing the quality of dental care in neighborhood health centers has been presented. The audit uses implicit review for the evaluation of the overall process of dental care and explicit review for the technical component of the clinical audit and the evaluation of the dental record. This combined approach is favored over a totally explicit audit because it is more flexible and efficient and less threatening to the dentist. Although the "soft" structure of this audit could be criticized, the major issue is that a useable, simple quality assurance mechanism has been successfully used to improved the quality of dental care. Modifications of criteria will certainly evolve as quality assurance mechanisms improve.


Mutual expectations in the process of joining a dental health group.

Productivity can be seriously affected when new persons join an existing group and little or no attention is given to the process by which that person becomes a member of the group practice. Parallels can be drawn between organizational management and the functioning of the dental team. Observations were made of three clinicians who attempted to join an existing dental delivery group. There are some predictable phases through which the joiner passes to acceptance or lack of acceptance in an existing group. Recommendations for groups to consider before either hiring or training members of a dental health group are given.


Asymmetrical dental caries and Streptococcus mutans infection.

A 27-year-old woman chewed unilaterally and had restorations and caries only on the right side of the dentition. The left side had a greater amount of soft and hard deposits and more severe periodontal disease. Plaque samples from occlusal and interproximal tooth surfaces were collected and cultured. The proportion of Streptococcus mutans of the total anaerobic count in the plaque samples from the right side was 1,000 to 10,000 times as high as from the left side. The proportion of S mutans of the total streptococcus was 6% to 20% on the right and less than 1% on the left side.


Preoperative and operative considerations in malignant hyperpyrexia.

Malignant hyperpyrexia is a condition characterized by fever and often by skeletal muscle rigidity usually triggered by the administration of general anesthetic agents. A review of the current literature is given to emphasize preoperative and operative considerations. An uncomplicated case is presented to illustrate the special care that these individuals require.


The radicular lingual groove: an overlooked differential diagnosis.

A periodontal abscess with symptoms simulating an endodontic problem is discussed. The diffculty of diagnosis, compounded by the apparent failure of endodontic treatment on an adjacent tooth, is described. This case history illustrates the importance of awareness of developmental defects in teeth and the potential problems that they pose.


Dental professional liability prevention: part one. Council on Insurance.

The purpose of the claims monitoring program of the Council on Insurance is to determine whether preventive measures can be implemented by dentists to eliminate, reduce, or better defend professional liability claims. This article outlined some of the findings and recommendations of the Council in the areas of informed consent and assisting in the defense of a professional liability claim. The remainder of the Council's findings and recommendations will be presented in the second part of the article. The Council believes that if its recommendations are followed dentists can improve the loss statistics for dental professional liability significantly.


Theoretical principles and technique of functional closure of the lip and nasal aperture.

Since many approaches to the closure of the cleft lip have not satisfied the hopes placed into them, the author has gone back to the principles stated by Veau (1938). His anatomical findings are presented. They form the basis of his technique of functional closure of the lip and nasal aperture: Careful dissection of all muscles involved, anatomical repositioning of all structures of the lip and the nasal entrance, and wide subperiosteal dissection. Careful reconstruction of a normal anatomical situation leads not only to better appearance and good mobility of the area concerned, but also to an enhanced growth of the underlying bony structures. Primary osteoplasty has been used, but does not seem to be necessary. The early results of this technique are very satisfying, however, later re-evaluation has to be made.


Long term follow-up of the sagittal splitting technique for correction of mandibular prognathism.

In a study of 67 cases the authors have investigated clinically and radiologically the long term results (5 years and over) of the sagittal split technique (Obwegeser 1955, 1957). Although 95% of the patients are satisfied, 60% have some impairment of sensation in the lower lip. This however goes unnoticed in 40% of these cases. The temporo-mandibular joint does not appear to be affected. 73% of the patients have excellent or good occlusion, while 18% have an unsatisfactory anterior occlusion due to some degree of relapse. The remaining 9% have poor occlusion without sign of relapse. A statistical analysis of the teleradiographs reveals that relapse is due to a rotation of the body of the mandible. Since several changes in technique have meanwhile been adopted, this paper will be followed by an analysis of the more recent cases.


Cutaneous necrosis of the chin following mandibular advancement and genioplasty. (Case report).

A case of necrosis of the soft tissue over the chin following mandibular advancement and genioplasty is presented. The aetiology, pathology, and clinical management of pressure sores is discussed.


Midface deviation due to mandibular fractures. (An experimental study with clinical comparison).

An experimental study was undertaken into the effect of fractures produced in the body of the mandible, the base of the condylar process and the mandibular condyles, on the bones of the middle third of the face using rabbit sucklings. The rabbits were sacrificed when fully grown, when it was found that in all cases the bones of the middle face had deviated to the traumatized side in comparison with the neurocranium. The greatest asymmetry occurred after injuries to the condyles and least following injuries to the body of the mandible. A comparative study on patients past growing age who had had an injury to the condyle before the age of 10 years suggested a similar disturbance of development. The present material, however, was so limited that reliable conclusions could not be drawn.


Radiological features of mandibular primordial cysts. (Keratocysts).

Primordial cysts (keratocysts) have been shown to have a greater tendency to recurrence than other jaw cysts. Some radiological features may assist in establishing the diagnosis. Thirteen mandibular primordial cysts have been studied radiologically in detail. Characteristic features are extension along the medulla with minimal expansion except in young children. Margins are generally sharply demaracated and either smooth or scalloped. Cortical resorption occurs before expansion. The cysts may displace adjacent teeth, particularly when unerupted, but generally do not produce root resorption. They may displace the neurovascular bundle. Antero-posterior dimensions in this series ranged from 28 to 77 mm, with a mean of 50 mm.


Synovial cyst of temporo-mandibular joint imitating a parotid tumour. (A case report).

A previously unreported case of a synovial cyst of a temporo-mandibular joint imitating a parotid tumour is described. A surgical approach involving a total mobilization of the facial nerve is outlined.


Experiences with 197HgCl2 in the diagnosis of head and neck malignancies.

197 Hg Cl2 (mercuric dichloride) was used in the diagnosis of 30 cases of epidermoid carcinoma of the head and the neck, and in 5 cases of benign tumours and non-neoplastic lesions. The results show that radioisotope scanning is not a certain method of diagnosis but that it affords supplementary information essential to correct therapy.


Preliminary report on radiation and heart disease.

Using data from the Tri-State and a mathematical model, the hypothesis that low levels of diagnostic radiation can produce both leukemia and heart disease has been tested. The range of radiation considered is within a factor of 10 of 5 rads (0.5-50 rads). Even at the lowest levels, an estimated 5% of the persons exposed suffer damage to the DNA which is subsequently expressed as heart disease or leukemia. The risk of heart disease in an affected group is roughly tripled and there is a 10-fold increase in the risk of leukemia according to preliminary estimates.


Computerization of three-channel thrombelastograph.

A small-size and low-cost microcomputer using an Intel 8080 micro-processer is employed to provide real-time data collection and reduction of a three-channel electronic-readout thrombelastograph (TEG). Computed values of significant clotting parameters are obtained instantly allowing for rapid analysis and monitoring of many patients. Computer hardware was designed to optimize signal sampling rates, processing time and storage.


Kinetics of methotrexate uptake by human tumor cells from routine pathological samples.

The kinetics of cell uptake of methotrexate were measured in vitro using primary human tumor cells from malignant pleural effusions, leukemic cells from leukopheresis samples, and normal tonsillar lymphocytes. The results were consistent with either passive diffusion or carrier mediated uptake kinetics, with the latter applicable only under conditions where the extracellular concentration of methotrexate was smaller than the drug-transport receptor binding constant. The intial rates of uptake for the same cell type differed signicantly between patients; however no differences in uptake rates were noted between cell types. All three sources of cells proved suitable for uptake studies. The results suggest that the variation in response in normally methotrexate responsive neoplasms, such as leukemia or lymphoma, may be due to between-patient differences in the cellular rates of methotrexate uptake.


Bioenergetics in clinical medicine XIV. Studies on an apparent deficiency of coenzyme Q-10 in patients with cardiovascular and related diseases.

Blood samples from 406 cardiac patients were analyzed by a differential assay of the specific activities (s.a.) of the succinate dhydrogenase-coenzyme Q-10 reductase to detect and quantitate existing deficiencies of coenzyme Q-10. 87/406, or ca. 20%, showed a mean lower basal S.A. and a mean higher per cent deficiency than a control group; both differences were significant (p is less than 0.001). The remaining 319 patients (80%) showed a negligible deficiency, but a mean low basal S.A., significant by p is less than 0.001. Cardiac patients may show low S.A.'s (sub-normal) of this CoQ-10-enzyme with or without a deficiency of CoQ-10. The desirable state for the patient is a normal level of the enzyme for bioenergetics and no deficiency of CoQ-10. Previously, a deficiency of CoQ-10 was found for cardiac biopsies from surgery; now, blood samples reveal the same deficiency. Frequent correlation between deficiencies in the blood and cardiac tissue is expected. This CoQ-10-enzyme in blood can aid patient selection for the clinical administration of CoQ-10 to cardiac patients.


Pharmacokinetics of theophylline in acute asthma.

Serum theophylline concentrations were measured in 17 children and adolescents with acute asthma who received an aminophylline loading dose of 7 mg/kg and a constant infusion of 15 mg/kg/24 hours. The mean total theophylline clearance rate was 1.32 +/- S.D. 0.66 ml/min/kg. Hypoxia, and in two patients, acidosis, did not appear to significantly influence theophylline clearance rates. Inter-individual differences in clearance rates were great. No child experienced symptoms or signs of theophylline toxicity during the study. If serum theophylline concentrations cannot be monitored readily, an aminophylline infusion rate of 15 mg/kg/24 hours can be used safely in patients with acute asthma, but in most patients this infusion rate will not provide serum theophylline concentrations in the desired therapeutic range of 10-20 microgram/ml. Monitoring of serum theophylline concentrations during aminophylline infusion is desirable in order to individualize infusion rates, and achieve optimal bronchodilation without toxicity.


Effects of medroxyprogesterone on the liver function and drug metabolism of patients with primary biliary cirrhosis and chronic active hepatitis.

Effects of medroxyprogesterone acetate on the clinical course of six patients with primary biliary cirrhosis (PBC) and chronic active hepatitis (CAH) were investigated. The response in all subjects was good; the subjective symptoms decreased, the liver function tests showed a tendency towards normal values. Furthermore, the levels of serum antibodies declined and the hepatic metabolic ability, as tested by serum albumin levels and indices of drug metabolism, improved. The beneficial influence of progesterone on the patients may be due to the immunosuppressive effect and enhancement of protein synthesis. The results suggest that medroxyprogesterone may be a valuable alternative for patients with autoimmune liver disease, particularly in cases developing resistance or undesirable reactions to the previous therapy.