Analysis of subunit organization in chicken erythrocyte chromatin.

Micrococcal nuclease digestion of intact chicken erythrocyte nuclei is shown to result in the formation of core nucleoprotein particles containing about 140 base  pairs of DNA. These core particles, which are almost entirely devoid of histones f1 and f2c, are derived from transient nucleoprotein particles containing an average of approximately 180 base pairs of DNA. Oligomers of these latter particles may be isolated after brief nuclease digestion. The time course of digestion of these oligomers demonstrates the existence of "spacer" regions of more accessible DNA between core particles. Redigestion of purified monomer core nucleoprotein particles gives rise to both single-strand and double-strand DNA fragment patterns similar to those resulting from digestions of chromatin in situ. This observation indicates that the core particles we isolate are representative of nucleoprotein structures existing within the nucleus.


Membrane perturbation: studies employing a calcium-sensitive dye, arsenazo III, in liposomes.

A metallochromic dye, arsenazo III [2,7-bis-(2-arsonophenylazo)-1,8-dihydroxynaphthalene-3,6-disulfonic acid], has been incorporated into the aquenous interspaces of multilamellar liposomes. multilamellar liposomes. Addition of Ca produced no shift in the absorbance spectrum of dye captured by liposomes, whereas disruption of liposomes by Triton X-100, followed by Ca, produced the spectrum chracteristic of the dye-Ca complex: evidence of latency. Addition of excess ethyleneglycol-bis(beta-aminoethyl ether)-N,N'-tetraacetic acid (EGTA) reversed the spectal shift. Differences between spectra obtained in this sequence yielded dye efflus. To measure Ca efflux, difference spectra (+/-EGTA) were obtained from cationic liposomes containing Ca after detergent lysis (sensitivity less than 10 mmol/ml). Since liposomes were impermeable either to dye or Ca until perturbed, it was possible to test a variety of membrane-active steroids (diethylstilbesterol, deoxycorticosterone, etiocholanolone) for their capacity to provoke dye efflux from liposomes; preincorporation of cortisol stablized liposomes against dye leak. Immunoglobulin-coated liposomes containing dye were taken up by phagocytes of Mustelus canis, and phagocytic vacuoles stained red-purple after ingestions. Liposomes containing the calcium-sensitive dye constitute a simple, accurate means for determining membrane perturbation and Ca fluxes; their uptake by cells or organelles remains to be exploited further.


Zein synthesis in maize endosperm by polyribosomes attached to protein bodies.

The protein bodies in maize endosperm are the sites of zein deposition. They are single membrane-bound vesicles with polysomes associated with the exterior surface of the membrane. These protein bodies were isolated by sucrose density gradients and characterized by electron microscopy and polyacrylamide gel electrophoresis. Polyribosomes dissociated from the surface of the membrane by detergent treatment were placed into an amino-acid incorporating system. Based on alcohol solubility, amino-acid composition, and molecular weight distribution, the product synthesized appeared to be largely, or entirely, zein. This suggests the existence of components which are specific for the synthesis of zein at the protein body membrane surface.


Interferon: purification and initial characterization from human diploid cells.

Interferon produced by human diploid fibroblast cells in culture has been purified approximately 5000-fold. The purified interferon, when analyzed by electrophoresis on polyacrylamide gel containing sodium dodecyl sulfate, contains only one polypeptide component of 20,000 molecular weight. The interferon activity comigrates with this polypeptide, indicating identity of the activity and the polypeptide. Oxidation of this polypeptide with periodic acid and subsequent staining with Fuchsin base indicates that it contains carbohydrate ans suggests that the human fibroblast interferon is a glycoprotein.


Chitin biosynthesis during Blastocladiella zoospore germination: evidence that the hexosamine biosynthetic pathway is post-translationally activated during cell differentiation.

De novo construction of a chitinous cell wall accompanies Blastocladiella emersonii zoospore germination. At least an order of magnitude increase in total hexosamine occurs during germination. This increase is into polymer (chitin) and occurs on schedule in the presence of cycloheximide. Uridine-5'-diphospho-N-acetylglucosamine (UDPGlcNAc), both the end product of hexosamine biosynthesis and a substrate for chitin biosynthesis, is a potent inhibitor of the activity of the first pathway-specific enzyme of hexosamine biosynthesis in zoospore extracts. Certain uridine nucleotides, not perceptibly influencing the activity of the first enzyme per se, counteract the inhibitory effects of UDPGlcNAc. The concentration of UDPGlcNAc in the zoospore is sufficient to act as an inhibitor of the enzyme, but the amount of UDPGlcNAc is sufficient, by over an order of magnitude, to account for the chitin synthesized during germination. Both the production of UDPGlcNAc and its utilization for chitin synthesis appear to be post-translationally regulated in zoospores and during zoospore germination.


Increase in type I and type III collagens in human alcoholic liver cirrhosis.

Collagen in bulk was isolated in about 30% yield from the livers of normal human beings and from livers of persons with alcholic cirrhosis. Analyzed chemically and examined by electron microscopy, the collagen in each case was shown to consist of two types identical with, or resembling closely, type I and type III collagens of skin. The collagen from normal liver was predominantly type I, whereas, that from cirrhotic livers consisted or approximately equal amounts of the two types. By chromatography on carboxymethyl-cellulose, the type I collagen from the cirrhotic livers showed one alpha2chain and two alpha1 chains. The alpha1 chains were separable from one another, but gel electrophoretic patterns of peptides obtained from them after treatment with CNBr were almost identical, and resembled the pattern obtained with CNBr peptides of the alpha1 chain of rat skin type I collagen. The increased collagen of both types was responsible in part for the observed distortion of the architecture of the cirrhotic livers associated with increased rigidity of the stroma. The predominance of type III collagen in the areas of collapse of architecture where, as shown by others, few fibroblasts are present, suggests that hepatocytes might have an important function in fibrogenesis during the course of liver cirrhosis.


Totipotency and normal differentiation of single teratocarcinoma cells cloned by injection into blastocysts.

A definitive test for developmental totipotency of mouse malignant teratocarcinoma cells was conducted by cloning singly injected cells in genetically marked blastocysts. Totipotency was conclusively shown in an adult mosaic female whose tumor-strain cells had made substantial contributions to all of the wide range of its somatic tissues analyzed; the clonally propagated cell lineage had therefore differentiated in numerous normal directions. The test cells were from "cores" of embryoid bodies of a euploid, chromosomally male (X/Y), ascites tumor grown only in vivo by transplantation for 8 years. The capacity of cells from the same source to differentiate, in a phenotypic male, into reproductively functional sperms, has been shown in our previous experiments [(1975) Proc. Nat. Acad. Sci. USA 72, 3585-3589]. Cells from this transplant line therefore provide material suitable for projected somatic and germ-line genetic analyses of mammalian differentiation based on "cycling" of mutation-carrying tumor cells through developing embryos. In some animals obtained from single-cell injections tumor-derived cells were sporadically distributed in developmentally unrelated tissues. These cases can be accounted for by delayed and haphazard cellular integration, and by a marked degree of sustained cellular developmental flexibility in early mammalian development, irrespective of certain classical "germ-layer" designations. All mosaic mice obtained have thus far been free of teratomas. In one case, the injected stem cell contributed only to the pancreas and gave rise to a malignancy resembling pancreatic adenocarcinoma. The high modal frequency of euploidy in these individually tested cells thus tends to indicate that a near-normal chromosome complement is sufficient for total restoration of orderly gene expression in a normal embryonic environment; it may also be necessary for teratoma stem-cell proliferation to be terminated there.


Regulation of expression of Adh genes in maize.

A regulatory mutant of the Adh (alcohol dehydrogenase) gene was induced by ethyl methanesulfonate. The mutation reduces the ability of the gene to complete for the limited gene activating factor. The mutant shows full activity in the homozygote but only one-half the activity of the progenitor gene in heterozygotes where it is competing with another allele for the limited factor. Evidence is presented for multiple regulatory sites in both the Adh and Adh2 loci.


Inheritance of killer phenotypes and double-stranded RNA in Ustilago maydis.

Three different killer specificities in U. maydis are inherited cytoplasmically and transmitted by cell fusion. Each killer generates low frequencies of specifically immune forms in crosses with sensitive strains. The properties of immunity to each killer are also inherited cytoplasmically and transmitted by cell fusion. Killer strains carry virus-like particles about 41 nm in diameter. Each killer possesses distinct double-stranded RNA components that range in molecular weight from 0.46 X 10(6) to 2.9 X 10(6). Two components are shared by all three killers. Immune strains possess new forms. Crosses and heterokaryons between different killers revealed unilateral or mutual restrictions that prevent inclusion of two killer specificities in the same cell.


Menkes disease: a biochemical abnormality in cultured human fibroblasts.

Cultured skin fibroblasts from patients with Menkes disease, an X-linked disorder involving a defect in copper metabolism, were analyzed for copper concentration by means of atomic absorption spectrophotometry. These cultures consistently exhibited elevated copper concentrations (mean = 335.5 ng of copper per mg of protein) when compared to control fibroblast cultures (mean = 59.2 ng of copper per mg of protein). External factors that could influence the copper content of cultures were found not to affect the differences in copper concentration between control and Menkes cells. Furthermore, Menkes cells could be differentiated from cultured fibroblasts of controls, of presumed heterozygotes, and of Wilson's disease patients by copper concentration. These observations led to the conclusion that the increased copper content of cultured Menkes cells was characteristic of Menkes disease, resulting from the expression of the genetic abnormality. This provides a genetic marker, a defect in metal metabolism demonstrated in human fibroblasts, that should prove valuable in both the diagnosis of Menkes disease and in the study of the fundamental defect of this genetic disorder.


Identification of mutagenic metabolites of benzo(a)pyrene in mammalian cells.

The mutagenicity of benzo[a]pyrene and 15 of its derivatives, which included phenols, the benzo[a]yrene-4,5-epoxide (the K-region epoxide), dihydrodiols, two isomeric 7,8-diol-9,10-epoxides, a 6-methyl derivative, and a 6-hydroxymethyl derivative, were tested with Chinese hamster V79 cells in order to identify the mutagenic metabolites of benzo[a]pyrene. Mutations were characterized by resistance to ouabain or 8-azaguanine. Since V79 cells do not metabolize polycyclic hydrocarbons, mutagenesis was tested both in the presence and absence of benzo[a]pyrene-metabolizing normal golden hamster cells. All the tested phenols, 4,5-diols, trans-9,10-diol, 6-methyl, and 6-hydroxymethyl derivatives of benzo[a]pyrene showed little or no mutagenicity for both genetic markers. The (+/-)7alpha,8beta-dihydroxy-9alpha,10alpha-epoxy-7,8;9,10-tetrahydrobenzo[a]pyrene and K-region 4,5-epoxide exhibited similar and moderate mutagenicity in the absence of benzo[a]pyrene-metabolizing cells, but the (+/-)7alpha,8beta-dihydroxy-9beta,10beta-epoxy-7,8,9,10-tetrahydrobenzo[a]-pyrene showed a 2000- and 270-fold higher mutation frequency for ouabain and 8-azaguanine resistance, respectively, than did the K-region 4,5-epoxide. The trans-7,8-diol which was not mutagenic in the absence of benzo[a]pyrene-metabolizing cells was more mutagenic than benzo[a]pyrene after metabolism and mutagenesis by trans-7,8-diol in these cells was inhibited by 7,8-benzoflavone, an inhibitor of mixed-function oxidases. Metabolically formed trans-7,8-diol was isolated and incubated with rat liver microsomes in the presence of co-factors. High-pressure liquid chromatography analysis indicated that the major metabolite of trans-7,8-diol is 7alpha,8beta-dihydroxy-9beta,10beta-epoxy-7,8,9,10-tetrahydrobenzo[a]pyrene. The results indicate that the latter compound is metabolically formed and the major mutagenic intermediate of benzo[a]yrene metabolism.


Attempts to locate residues in complementarity-determining regions of antibody combining sites that make contact with antigen.

From collected data on variable region sequences of heavy chains of immunoglobulins, the probability of random associations of any two amino-acid residues in the complementarity-determining segments was computed, and pairs of residues occurring significantly more frequently than expected were selected by computer. Significant associations between Phe 32 and Tyr 33, Phe 32 and Glu 35, and Tyr 33 and Glu 35 were found in six proteins, all of which were mouse myeloma proteins which bound phosphorylcholine (= phosphocholine). From the x-ray structure of McPC603, Tyr 33 and Glu 35 are contacting residues; a seventh phosphorylcholine-binding mouse myeloma protein also contained Phe 32 and Tyr 33 but position 35 had only been determined as Glx and thus this position had not been selected. Met 34 occurred in all seven phosphorylcholine-binding myeoma proteins but was also present at this position in 29 other proteins and thus was not selected; it is seen in the x-ray structure not to be a contacting residue. The role of Phe 32 is not obvious but it could have some conformational influence. A human phosphorylcholine-binding myeloma protien also had Phe, Tyr, and Met at positions 32, 33, and 34, but had Asp instead of Glu at position 35 and showed a lower binding constant. The ability to use sequence data to locate residues in complementarity-determing segments making contact with antigenic determinants and those playing essentially a structural role would contribute substantially to the understanding of antibody specificity.


Antagonism of 5-hydroxykynurenamine against serotonin action on platelet aggregation.

Serotonin induced an aggregation of human platelets, whereas 5-hydroxykynurenamine, produced from serotonin by the action of indoleamine 2,3-dioxygenase, did not cause any significant degree of platelet aggregation. 5-Hydroxykynurenamine specifically inhibited both a  serotonin-induced aggregation of platelets and the potentiation of the ADP-induced platelet aggregation by serotonin. It did not, however, alter the profiles of the platelet aggregation induced by ADP, collagen, or adrenaline. The degree of inhibition was proportional to the time of preincubation of platelets with 5-hydroxykynurenamine, and to the concentration of 5-hydroxykynurenamine used. Available evidence indicated that 5-hydroxykynurenamine completed with serotonin for the same receptor sites. Studies with analogues of 5-hydroxykynurenamine indicated that the substitutions of 0-amino-benzyl moiety with hydroxy or methoxy groups were somewhat tolerated, whereas the masking of alkylamine moiety with N-acetylation completely lost the inhibitory activity.


Clustering of replicating cells in aortic endothelium.

Cell division in the aortic endothelium of the rat is not randomly distributed. Maps of the aortic surface show focal areas where the daily rate of replication may be in excess of 50%. This implies the existence of focal areas of rapid cell growth or rapid cell turnover and other areas where growth or turnover is largely absent.


Parietal eye of the lizard: neuronal photoresponses and feedback from the pineal gland.

The parietal eye of the lizard responds to illumination by sending afferent impulses to the pineal gland during daylight, the photophase. The pineal gland has efferently conducting neurons which are especially sensitive to norepinephrine and whose feedback to the parietal eye enhances its photo responsiveness. During the scotophase, at night, the eye generates afferent impulses to the cessation of light and the pineal efferents are most sensitive to serotonin. Thus, the photo-and chemoresponses of this system of interacting neurons are nearly reversed during the two phases of the daily photoperiod of the lizard.


Genetic variability in krill.

We have estimated genetic variability by gel electrophoresis in three species of krill, genus Euphausia (Arthropoda: Crustacea). Genetic variability is low where trophic resources are most seasonal, and high where trophic resources are most stable. Simlar trends have been found in benthic marine invertebrates. The observed trends of genetic variability do not correlate with trends in the stability of physical environment parameters.


[Clinical significance of thermographic measurements for differentiation of malignant and benign bone tumors (author's transl)].

Data for evaluation of 74 thermograms of the extremities in patients with bone tumors are presented and discussed. Correctly performed thermography may in single cases be a contribution for other diagnostical investigations.


[Jaw block at maximal mouth aperture in subcondylar fractures in the very young child].

In one case involving post-traumatic temporo-mandibular ankylosis, the authors suggest a means of bi-maxillary blockage at the maximum buccal aperture which they consider prevents this type of complication in very young children presenting with bicondylar fracture. The simplicity of this method, the possibility of carrying it out where the milk teeth are not yet complete, the fact that it is well-tolerated by the children it has been tried out on, make this, in their opinion, the procedure of choice.


[Treatment of an old temporomandibular joint luxation].

The authors present a case of longstanding luxation of the left temporo-mandibular joint, leading to prognathism with lateral deviation. The functional and aesthetic problems due to this deformity were advantageously corrected by saggital cleavage of the ascending left ramus, after previous orthodontic treatment and study on Chateau's articulator.


[A case of post-traumatic ischemic necrosis of the tongue].

Moving and sensory organ, the tongue have a capacity to heal easily because it is a well vascularized muscular mass. Refering to this wellknown notion the author reports one case of post traumatic ischemic necrosis which has been causing the loss of more than a half of the tongue. The etiological problem is not resolved.


[Facial phycomycosis. A propos of 2 cases].

Among deep mycoses, sub-mocosal phycomycosis due to Entomophthora Cornata is of interest to stomatologists as it is mainly located in the middle and lower areas of the face. symptomatology is characterized in general by upper naso-labial deformation the extent of which is dependent on the stage of development reached. The only means of identifying the nature of the lesions is by biopsy which always enables diagnosis of deep mycosis to be made and sometimes, by means of a culture, identification of the agent responsible. This is a lower saprophytic fungus of decaying vegetable and telluric matter. It usually enters the body through the mucous membrane when there is a traumatic fissure. Ingress through the teeth should not be overlooked. Antifungal preparations and reconstructive surgery constitute the treatment early application of which determines prognosis.


[Facial manifestations of suppurative trichophytosis].

Several cases of facial suppurative Trichophytia described by the authors lead to a review of the clinical, mycological and pathological features of this disorder which is on the increase in the region of Nantes.


[Fronto-malar osteosynthesis by means of screwed plates].

The external orbital apophysis provides a zone of solid anchorage for the treatment of fractures as well as for the immobilization of osseous fragments after facial osteotomy. While proposing new miniaturized material the authors present 45 cases of fronto-malar osteosynthesis carried out in one year. They recall that solid immobilization by plating avoids inter-maxillary blockage, and is the only means of restraint among those presently used which is capable of opposing late post-operative recession. Consequently after facial osteotomy, the plates are left in place for 12 months. They are removed under local anethesia.


[Osseous desmoid fibroma of the mandible, a propos of 1 case].

Osseous desmoid fibromas, analagous with soft tissue desmoid fibromas, are rare tumors with exceptional localization in the mandible, revealed by: -tumefaction and trismus in usually very young subjects; -the radiological picture is that of lysis with relatively well defined limits, but with no double outline, with possible cortical rupture and aberrant lacunae far from the main focus which explains possible recurrences of this tumor which is nevertheless benign. The main histological danger is confusion with a differenciated fibrosarcoma. Mandibular resection which is frequently necessary should ensure stable recovery.


[Oblique oval deformation of the upper dental arch and arciform deviation of the face in unilateral cleft lip].

Abnormal muscular equilibrium due to unilateral cleft-lip is responsable for deviation of the center of the face and of the outline of the upper lip towards the healthy side. This deviation is constant but is variable in intensity. By taking precautions in the neonate it can be attenuated, particularly by orientation of the bottle. The degree of perfection of muscular suturing in the region of the nasal threshold is the basis of reestablishment of early normal muscular equilibrium. The quality of the primary treatment decreases the degree of importance of facial sequelae but risks aggravating the contraction of the upper lip if not followed-up pre- and post-operatively with orthodontic treatment.


[Reflexions on labial topography].

The musculature of the lips contributes to oro-facial muscular equilibrium. Labial topography at rest is extremely variable, as there may be gaping of the lips with a short upper lip and associated protrusion of the upper alveolar process, as well as on the contrary an upwardly displaced stoma leading to incarceration of the upper dental arch by the lower lip and retrocession of the laveolar process (stoma syndrome). Anomalies at rest justify surgical treatment.


[Study of an anatomical approach to the lower wisdom teeth and their roots: the lingual route].

The authors describe the theoretical arguments which incited them to practise a lingual approach for avulsion of the lower wisdom teeth and their roots. In their account and the photos which illustrate it, they show the advantages which the use of this route provides: -simplicity, -surgical comfort for the patient, -rapidity, -and quality of surgical after-effects. The latter are analyzed from statistical tables collected on 308 cases corresponding to the avulsion of 364 wisdom teeth or roots.


[The G.R.F. glue in stomatology, present technics for its utilization].

The utilization technique has been slightly modified with use. At present, the glue is prepared in advance and kept in closed 5 ml. syringes. Formalin is no longer applied in the liquid form by means of a syringe and needle; but only with Spongel swabs impregnated with formalin and cut to the size of the bleeding point. This prevents the formalin from leaking on to the mucosae and burning them.


[500 cases of general anesthesia without intubation with preservation of the pharyngolaryngeal reflexes].

The authors performed 500 anesthesia with ketamine hydrochloride, 302 in children and 198 in adults. Its advantages are: -short term anesthesia, -no intubation. The disadvantages are minimal, and we had no accidents with this anesthetic.


[The contribution of sulpiride to ketamine anesthesia].

The authors think that it can be asserted that Sulpiride protects the patient from neuropsychic effects of Ketamine in an almost complete manner, and this without prolonging the sleeping time, or depressing circulation or respiration.


[Technical improvement of oro-pharyngeal packing].

Protection of the air passages during intra-buccal interventions under general anesthesia, is necessary. Oro-pharyngeal packing is one of the means of this protection; it can be easily carried out by means of a plastic sponge, which is more simply and rapidly positioned, more impervious, less traumatic and less disturbing than classical packing with a gauze bandage.


[Plea for the application of statistical methods by computer to stomatological research].

In face of the double reflex of fascination and defiance which is right away created by statistical methods by computers, the authors have attempted by means of precise examples to demystify these methods by recalling: 1) That computer statistics can be defined as the association of a service and a machine, the combination should be considered as an instrument and only an instrument. 2) That the application of computer statistics to odonto-stomatological research of course evidently enables the resolution of problems which would be otherwise insoluble, but above all considerably enlarges the field of research by rendering visible phenomena which would otherwise remain hidden. In this way, statistical methods by computer can be compared with the microscope; a low magnification with the optical microscope justifies only an overall view of the section while changing to higher magnifications permits the demonstration of details which would remain unsuspected. Use of the electromicroscope opens up another world for research. 3) In the same way as the biologist who uses the microscope, if he knows the principle of it is not in so far a specialist in optics, neither does the research woker who uses statistics necessarily have to be a trained statistician, on the one condition that evidently he disposes of professional computer logistics. This is the case of the ACB (Nantes) rush technical units, who cosigned this work, where the engineers who pose the problems to be resolved and emit the working hypotheses from the results supplied by the statistical studies are not the same people who carry out these very studies. 4) An essential fact, the research worker's independance is complete, only he can pose the problems and emit the hypothesis from the correlation, i. e. point of fact concomitance between the various isolated parameters. It therefore does not seem that weighty statistical techniques presently occupy the place of choice which should be theirs in stomatological research and more particularly in research concerning growth and development of the face where their use seems to be electively implied in face of the number and complexity of the parameters looked at.


[Post-transfusion HL-A alloimmunization in acute leukemia].

Patients with acute leukemia (AML and ALL) who received multiple transfusions of whole blood, platelets or granulocytes, may develop anti-HL-A immunization in spite of chemotherapy. The frequency of HL-A alloimmunization was studied in 21 patients with AML and in 11 children with ALL. Multispecific HL-A antibodies were detected in 10 patients with AML and in 8 with ALL. The presence of these antibodies was associated with febrile transfusion reactions and with immediate destruction of platelets or granulocytes. Selection of HL-A compatible donors eliminated those reactions and the platelet counts could be maintained at levels sufficient to avoid the risk of hemorrhage. It seems therefore warranted to transfuse exclusively HL-A compatible platelets or leukocytes, as soon as anti-HL-A immunization has been detected.


[Attempt at a statistical analysis of the values of the free-way space measured on a sample of 54 patients].

The measurements of the free-way space (= distance between physiologic rest position and centric occlusion) vary according to the method used. In order to get a more distinct reference point, the authors suggest tattooing the Menton (lowest chin point) rather than the Pogonion (most anterior chin point). The free-way space measured in this study ranged from 0.5 to 8 mm. 75% of all cases examined revealed a free-way space between 1 and 2 mm and only 5% showed extreme values such as 0.5 and 8 mm. In contrast to Thompson, who believes that the vertical dimension of occlusion equals the vertical dimension in rest position minus 2 mm the results of this study are in agreement with the findings of those authors, who observed an individually great variation of the free-way space.


[The dental passport as an aid to identification].

For the dental identification of unknown human bodies it is necessary to have unmistakeable comparative data. Such information can be made available by a "dental passport" which contains the complete present status of the dentition.


[The caries prevention campaign in the Canton of Zürich during 1962-1974 along with a statistical result report from the first 8 years].

In November 1962, a caries prophylactic campaign was inaugurated in the canton of Zurich. At the end of 1965, two thirds of the communities, 115 of 171, had introduced already toothbrushing with fluorine compounds at school, under supervision. The following years though did not bring notable increase in participation of the remaining communities. Here are the main results of the campaign: -reduction of dental caries in the permanent dentition by 45 to 50% (fig. 2) -reduction of dental caries on cuspid and incisor teeth and on the buccal and lingual surfaces of lateral teeth by about 80% -reduction of first molar extractions (fig. 5) -massive reduction of the number of untreated carious teeth (table VI) -better condition of the deciduous dentition (fig. 6, 7) -reduction in the incidence of gingival inflammations (table VII, fig. 8) -reduction of the supra- and subgingival calculus deposits. It is deduced from the discussion that supervised toothbrushing with fluorides, the spread of fluoridated toothpastes, and in a lesser degree--the fluoridation of table salt are a certain cause for the massive improvement of juvenile dentitions. It is still uncertain whether the avoidance of sugar containing snacks have also contributed to the favourable result. The reduction of gingival inflammations can only be explained by the improved home care. It cannot be proven if this has also an influence upon caries incidence.


[Dental caries in preschool children in Zürich].

Since 1956, Kindergarten children of the city of Zurich are annually examined and instructed, in presence of their parents, for adequate home care. The results of 19 years of activity are shown. While formerly, the differences in districts of different social-economic structure were large, they have slowly disappeared owing to constant education of children and parents in preventive measures. The second part is an evaluation of an epidemiological study of children who, on the day of examination, were 5 years +/- 2 weeks old. The approximate half of the children, who received fluorine tablets from birth, had--as was to be expected--a high percentage of caries free dentitions. The results show that an untiring effort for prophylaxis, inspite of often adverse circumstances, begins to bear fruit.


[Selective intensive prophylaxis for the farreaching prevention of dental caries, gingivitis and periodontitis in the school child].

Until about 1970, clinical studies showed a caries inhibition from 20-70%. Newer preventive programs have brought about an almost complete disappearance of caries and gingivitis. Generally speaking the preventive measures at the school level shows that the majority of children responds with reduced or completely eliminated caries incidence, but that a minority still remains heavily caries and gingivitis active. Such children are selectioned and submitted to intensive programs. They are ordered to the dentist or the school clinic every month and are instructed and checked. Thus the restorative needs are considerably reduced and with them, expenditure.


[A classification of articulators].

A classification of articulators is presented. 4 categories and 9 subdivisions are based on articulator design, records required, and possible occlusal schemes.


[Dentinogenesis imperfecta: a structural and ultrastructural study].

Histopathology of dentinogenesis imperfecta shows a haphazard distribution of dentinal tubules as well as changes in their diameters, sometimes narrowed, sometimes widened. These tubules appear as bundles or sheaves. This kind of dentine is often similar to secondary (also called tertiary) dentine, only mantle dentine preserving a normal structure. There is a complete obliteration of the pulp chamber and an almost complete obliteration of the root canal. Through SEM, the tubules appear to be few in number, their diameters are small and their fine ramifications are intricate through all planes. An heterogenous intertubular substance can be seen. Through TEM, collagenous fibers appear to be uncalcified or incompletely calcified, with a haphazard distribution. There are wide differences in the sizes of crystals and numerous spaces appear between crystals and collagen. Differences between the ultrastructure of human dentinogenesis imperfecta and the dentine of some lower vertebrates are clearly pointed out.


[Partial vestibuloplasty with secondary epithelization].

After description of indication and method of partial vestibuloplasty with secondary epithelization, the experiences with 61 treated cases are described. It was found that inspite of pronounced danger of recidivation in maxillary cases very useful results can be obtained by proper indication. This was confirmed by the referring dentists. The few cases of mandibular vestibuloplasty showed that in general it is not indicated. Of 5 cases, only one showed a durable good result while all other cases recidivated.


[Studies on the personality structure of patients with myoarthropathy].

A group of test patients afflicted with myoarthropathy was compared by psychological tests to a control group and was shown to differ significantly in their personality. The differences: the group of patients shows a stronger disturbance of general psychosomatic behaviour. There is no evidence of open aggressivity, on the other hand the patients are irritable, easily disappointed and concerned and generally depressive. This picture is rounded off by the "typical female selfdescription" in Scale 12. The investigation shows that "primarily" somatic patients should be, in greater measure, considered from the aspect of psychohygiene or psychotherapy.


[Effect of an electric field on the penetration of fluorides into dental enamel, studied in vitro and in vivo].

The aim of the present study is to determine the influence of iontophoresis on the deposition of fluorine in dental enamel. A micromethod of fluorine-deposition and of dental enamel-sampling was perfected in vitro; it was then applied in vivo. Fluorine was layed down by topical and iontophoretical way, under the form of sodium fluoride in neutral solution. In in-vitro and in 2 in-vivo asseys 18F was used as an indicator, while in other ones fluorine was titrated by mean of a specific lanthan-fluoride electrode. Results from both methods agree. It is stated that the fluorine deposition on enamel remains lightly but significantly higher, in vivo as well as in vitro, when the tooth is subjected to a continuous electrical field.


[Questionnaires on the professional activities of graduates from schools for dental assistants].

In a questionnaire sent to alumnae of Swiss schools for dental assistants the choice of the profession, the schools themselves, working conditions for the pupils and the causes for changing the profession or giving it up were examined. Answers and evaluation occurred still during and under the influence of the economic boom, when assistants were able to find employment easily. Questions of salary therefore stood in the foreground, next were working conditions. It is positive to note that the formation of dental assistants in completely privately organized schools shows good results. The changed circumstances in the economy call for a reevaluation of the concept of schooling.


Studies on spinal ascending pathway for effect of acupuncture analgesia in rabbits.

The effect of acupuncture needling in hindlimb points on the threshold of pain arising from the radiant heat applied to the snout of the rabbit has been evaluated both before and after various surgical lesions produced in the spinal cord. Section of the dorsal column alone at the level of T12-L1 could not produce any detectable change either of the pain threshold or of the effect of acupuncture on the pain threshold. Nor could the superficial lateral cordotomy seriously affect the analgesic effect of acupuncture. However, a lesion placed in the ventral two thirds of the lateral funiculus on the contralateral side could abolish almost completely this effect.


Protective effect of a mixture of radioprotector substances (mexamine and cystamine) on the haematopoietic stem cells of mice.

A protective effect of the mixture of radioprotectors (mexamine and cystamine) on the haematopoietic stem cells of the spleen and bone marrow was studied in mice irradiated by a dose 700 R in different time intervals after intraperitoneal injections of the substances. The protective effect of the mixture against the lethal radiation effects outlasts till the 90th minute after the injection, as well as the protection of the haematopoietic stem cells in the bone marrow. D0 of the regression lines of the survival of endogenous colonies in the spleen (ESC) increases up to 340 R after irradiating the mice in the 15 min interval after the injection of the protective substances with a subsequent decrease to the level of the control group (100 R). The D0 values of CFU survival in the bone marrow does not change; however, in the interval up to 60 min after the injection complete reparation of the radiation damage takes place after an exposure to 100 R. The recovery from the damage to the erythropoiesis followed by an incorporation of 59Fe into the bone marrow and spleen is the faster the higher a number of CFU survived the used radiation dose. The importance of a decrease of the radiation damage to the small intestine for the total protective effect of the mixture of radioprotectors is discussed.


[The effect of tetracycline antibiotics on the calcium and magnesium content of rat incisors].

Using electron probe microanalysis, the authors determined the calcium and magnesium contents in the incisors of rats treated with different doses of tetracycline and oxytetracycline, and in those of untreated rats. The contents of these elements were significantly lower in the dentine of the treated animals than in that of the control animals, whereas the enamel samples showed no statistically significant differences. The concentration tendency in different tooth sections, from the periphery to the pulp canal, i.e., decrease in calcium and increase in magnesium, was not influenced.


[Comparative radiological studies on the incidence of primary caries in treated vital and devitalized teeth].

The non-filled proximal areas of 709 vital and devital teeth with metal fillings were examined radiologically for primary caries. The findings were almost identical (Table 2). The somewhat higher prevalence of primary caries in vital teeth (Table 1) may be explained by the more drastic removal of predilection sites in devital teeth, which is due to the necessarily more extended cavity preparation.


[Stomatological morbidity study--Berlin 1972. 5. Caries frequency].

Using the DMF index, the authors studied the caries morbidity in a representative sample of the Berlin population (3853 subjects, aged 18 to 100 years). The mean DMF index was 17.74, the value for female individuals being higher than that for male ones.


[Presentation of a portable mouth irrigator. Possibilities of improving the cleansing effect and the activation of the peripheral blood flow in periodontal prophylaxis and therapy].

Oral irrigation is an approved procedure in periodontal prophylaxis and therapy. The author describes a portable oral irrigator and explains its design principle and working. By using new constructional elements (such as the swirl nozzle at the front of the mouthpiece) and by impulsing individually the flow of liquid via solenoid valves which are controlled by timing components, it is possible to improve the cleansing effect as well as the massage effect (in the sense of an activation of the peripheral blood-supply to the periodontium).


[Thrombophlebitis of the sinus cavernosus].

A short survey of the relevant literature is followed by the description of the clinical course of a thrombophlebitis of the cavernous sinus. In this case, the initial focus was an infection of a canine which caused thrombophlebitis via the anterior facial vein. The healing must be attributed to the immediate application of broad spectrum antibiotics and removal of the primary focus.


[Special aspects of the suction technic].

A right-angled cannula is presented that is suited for unhindered suction in the regions of the left maxilla and mandible and of the upper anteriors.


[Bacteriological studies during conservative treatment of periapical inflammations].

32 teeth with the diagnosis of periapical osteitis (established by clinical and radiological examinations) were subjected to endodontic treatment (irrigation with hydrogen peroxide), the course of which was followed by bacteriological examinations. The timing of treatment termination depended solely upon clinical evaluation. The examination of smears taken before the last irrigation showed that 26 of the 32 root canals (81%) were germ-free; in 2 cases, an anaerobic infection was still extant; and in 4 cases, an aerobic infection was observed. The high percentage of root canals which were germ-free before the last irrigation testifies to the efficiency of hydrogen peroxide application for disinfecting root canals on the one hand, and demonstrates the good agreement between clinical and bacteriological findings on the other hand. The germs identified belonged mainly to the normal oral flora. Enterococci proved to be particularly resistant. The conservative treatment of periapical osteitis by means of root-canal disinfection with a hydrogen peroxide preparation ans subsequent root-canal filling with a calcium peroxide paste is recommended.


[Evaluation of studies on the optimal impact pressure of the fluid stream in mouth irrigation].

To make comparable literature data on liquid pressures achieved with different devices and nozzles in oral irrigation, it is necessary to indicate not only the initial pressure in the feed pipe but also the actual pressure of the liquid jet upon the tissue. Using a special technique of his own, the author demonstrated that the pressure in the nozzle is considerably reduced by employing a supplementary swirl nozzle. The hypothesis that, when treating inflammatory periodontal diseases, the impact pressure of the liquid jet should not exceed considerably the inner pressure of the arterioles, capillaries and venules was corroborated.


[Stable osteosynthesis in mandibular fractures using cold polymerizing polymethylmethacrylate "Kallocryl-K"].

The author describes a method for the stable osteosynthesis of mandibular fractures. Prefabricated cups of cold-curing poly(methylmethacrylate) were fixed to the fragments by means of freshly mixed methacrylate, which produced their stable union for the period of healing. Uneventful healing was confirmed by clinical and radiological examinations. Side-effects on the cardiovascular system which may be caused by the residual monomer were not observed.


[The diagnosis of condylar process fractures].

The detection of condylar process fractures by clinical examination and the interpretation of radiographs belong to the stomatologist's diagnostic tasks. On the contrary, the exact location of the fracture lines and the recognition of the types of proximal fragment displacement often present problems. Diagnostic errors may also occur, mainly resulting from radiological illusions. The comprehensive evaluation of the data from 3027 patients with injuries of the facial bones, involving 1050 condylar process fractures, and the verification of the relevant radiological findings permitted to determine the location of the fracture lines and the types of fragment displacement, to recognize misinterpretations and to give suggestions for establishing a definite diagnosis.


[Symbol-documentation of stomatological data--a basis for discussion].

The author puts on discussion symbols for the rapid and informative recording of stomatological findings and for the marking of the most important therapeutic measures. The present condition should be marked, respectively, in blue and black; and the plan of treatment, in red. Any therapeutic measure achieved will be retraced on the chart in blue or black. The actual condition of treatment will thus been read in the chart at a glance.


[Working posture during the treatment of a slightly reclining patient].

Allowing for the work areas, the sequence of operations and the kind of treatment under direct or indirect vision, the author proposes working positions for sit-down dentistry which harmonize with the patient's posture.


[Pain relief by percutaneous cervical cordotomy in urological patients (author's transl)].

Percutaneous cervical cordotomy is excellent for extended elimination of pain, also in urological cases. A report of four cases is presented.


[Clinical course of Haemonchus infection in experimental invasion in lambs].

Eight 2-month-old lambs, divided into two groups, were experimentally infected with 5000 and 2500 larvae of H. contortus. It was found that the infection assumes a course with well manifested clinical symptoms, diarrhea, lowered appetite, stunted bodily growth, anemia, eosinophilia and lymphocytosis. Both the clinical symptoms and the parasitologic aspects are dependent on the extent of the infection. The total content of Ca and of the blood serum drops, and the amount of Mg fluctuates within the normal range.


[A pool hemopoietic stem cells and resistance of mice to toxic substances depending upon food rations].

Tests set up on male-mice of the CBA/I lineage demonstrated that fat carbohydrate rations of 1:7.3 and 1:3.8 in granulated combined fodder tend to increase the number of stem cells in a statistically fashion. Among mongrel mice kept on a ration with 7 per cent of fat a combination of mexamine with AET was found to loose some of its toxicity.


Impaired humoral immunity in PNG Highlanders.

Immunological function was investigated in 42 adult Papua New Guinea villagers and 38 adult males who had been inmates of the Goroka prison for more than three months. Serum IgG, IgA, IgM and IgE levels were all significantly elevated in both Papua New Guinea groups when compared to Australians. Antibody responses to tetanus toxoid immunization were greatly impaired in both Papua New Guinea (PNG) groups. The impairment was greater in the villagers. Antibody responses to immunization with typhoid vaccine were also impaired in both P.N.G. groups compared with Australians. Some evidence was obtained to indicate that unresponsiveness was associated with lower serum albumin levels, suggesting a relationship to protein deprivation. Antibody response after first immunization was predominantly in the IgM class for both tetanus and typhoid vaccines, with conversion to the IgG class on re-immunization. This indicates that most P.N.G. highlanders have not been exposed to these antigens previously. The prevalence of autoantibodies (mitochondrial, gastric parietal cell and antinuclear) was similar to that of a normal Australian population. The prevalence of smooth muscle antibodies, although higher, was probably not remarkable. Australia antigen was found in 9%, compared with less than half of 1% in the Australian population. Cellular immune function, as measured by delayed hypersensitivity reactions, was not impaired. The implications of these findings for mass immunization programmes are discussed.


Levels of reduced glutathione in red cells of New Guinea western Highlanders.

Reduced glutathione levels in erythrocytes of 14 Enga New Guinea Highlanders had a mean value of 50.1 mg/100 ml (S 5.9) which was significantly lower than the mean value of 67.9 mg/100 ml (S 9.7) found in 16 normal Caucasian Australians (P less than .001).


Iron content of native foods.

Chemical analysis showed that some foods cooked in a cast iron pot gained significantly in iron content. This was particularly so for rice and green vegetables, but not for the major root staples of Papua New Guinea. It therefore seems unlikely that a campaign to encourage the use of iron pots for cooking would significantly increase the iron content of diets in Papua New Guinea to an extent which would mitigate the high prevalence of iron deficiency.


Haemophilia A in PNG.

A three year  old Highland boy presented with unilateral swelling of the knee. Specific coagulation factor assay confirmed the clinical diagnosis of Haemophilia A. Brief mention is made of other recently detected patients in Papua New Guinea and aspects of management.


Working towards a village technology: recycling waste.

An account of the Construction of a Hospital waste Digester.


Protein versus energy in Papua New Guinea.

Protein deficiency has in the past generally been considered the main nutritional problem in the world. This has unduly detracted attention from the need for an adequate energy intake. Using surveys from different areas in Papua New Guinea, it is shown that deteiled investigations are needed to determine actual nutritional needs. In the Sepik a severe energy deficiency was found to be the principal problem. In some Highland areas, on the other hand, a distinct protein deficiency was observed, compounded by a low energy intake in the under 5-years age group. These distinct dietary patterns require a vastly different approach to nutrition intervention. It is shown that nutritional needs in the Sepik could in principle be met by increasing the availability of staple foods. An emphasis on protein would be a misdirected effort for most areas there. In the Highlands emphasis should be placed on legumes particularly those with a high energy value. This could close the protein gap and help to meet the caloric needs of young children.


Some clinical laboratory values for New Guinea Highlanders.

The paper outlines the results of a number of haematological and biochemical tests performed on 60 apparently normal Highland blood donors at Goroka in the Eastern Highlands District.


A modern approach to the management of acute blood loss.

Blood loss of less than 15% of circulating blood volume, that is, about 10 ml/Kg of body weight, can be treated adequately without blood transfusion. Patients who have lost more than 10 ml/Kg of body weight of blood, require oxygen and infusion of adequate volumes of electrolyte solution rapidly, followed by transfusion of a volume of blood approximately equal to the volume of blood lost. Plasma expanders, such as Stable Plasma Protein Soultion (SPPS) may be indicated where there is an unusual delay in the availability of crossmatched whole blood.


Mycetoma in PNG with special reference to a case of extradural mycetoma.

An account is given of 6 instances of mycetoma found in Papua New Guinea. One of these occurred in a 16 year old girl presenting with paraplegia due to a solitary extradural spinal myectoma, diagnosed only after laminectomy.


Submucous fibrosis.

The first recorded case of submucous fibrosis in a Chinese woman in Papua New Guinea is described. The essential clinical and pathological characteristics of the condition are presented and a scheme of management suggested. The pre-cancerous nature of the disease and the need for early diagnosis and regular review of affected patients are stressed.


Anaemia in the lower Ramu area.

The difficulty of defining anemia by haemoglobin concentration level arises from the continuous nature of the underlying distribution. Elwood's view that 7-8 gms/100 ml is a resonable criterion level accords with the data provided from a limited survey in the lower Ramu area. In the same area, there has been a decline in prevalence of clinical anaemia 1962-72 attributed to increased usage of treatment facilities.


Spinal lesions, paraplegia and the surgeon.

Thirty-six patients with spinal cord lesions and varying degrees of paraplegia were seen by the surgical team at the Angau Memorial Hospital, Lae, over a thirty month period. Because the continued presence of a spinal lesion may lead to progressive cord destruction and ischaemic myelopathy, prompt treatment is advocated. The depressing results that have followed treatment of fracture dislocations of the cervical spine and secondary neoplasm with paraplegia is recorded and some suggestions are made that may improve the outlook in future cases. Early and major surgery is advocated in the treatment of spinal abscesses, tumours, Pott's paraplegia and unstable fracture dislocations of the lumbar spine.


Compartment syndromes.

A patient is presented who developed the Compartment Syndrome, following blunt trauma to the lower limb. A "fibulectomy-fasciotomy" was performed. This allowed restoration of normal peripheral circulation of the limb but failed to prevent ischaemic necrosis developing in the anterior tibial, peroneal and posterior tibial compartments. Compartment Syndromes in the lower limb are discussed, with a view to their early recognition and management.


Infections of the hand.

In this paper the importance is stressed of the dangers associated with neglecting hand infections in Paua New Guinea, where, for understandable reasons, there is a tendency for people to be slow in seeking treatment. The prevention of hand infections is emphasised, and the principles in regard to rest, antibiotic therapy, and surgical decompression are discussed. The more common types of hand infection are described, with particular reference to surgical anatomy and surgical drainage. Some of the more complicated infections such as middle palmar and thenar space infections, suppurative tenosynovitis, osteomyelitis and septic arthritis are of sufficient importance to warrant the attentions of the specialist surgeon when this is possible.


Primary eye malignancy in Papua New Guinea.

Primary eye malignancy presenting in Papua New Guinea over a twelve-year period is surveyed. Subsequent cases presenting at Angau Memorial Hospital, Lae, are mentioned. Primary malignancies of the eye and orbit in general are discussed with particular emphasis on retinoblastoma.


Chondrosarcoma of the maxillary antrum presenting as exophthalmos.

A Papau New Guinean patient with a chondrosarcoma of the maxillary antrum producing exophthalmos is presented. The importance of considering causes other than thyrotoxicosis in the aetiology of exophthalmos is stressed and a summary of the clinical features, pathology and management of the tumour is given.


Unilateral proptosis.

A series of 22 cases of unilateral proptosis at Angau Hospital, Lae, presenting over a 22-month period are analysed. The cases are discussed individually with emphasis on aetiology, treatment and prognosis. The differential diagnosis of unilateral proptosis is outlined.


The cytologic diagnosis of breast lesions.

In view of the increasing number of patients presenting with breast lesions, cytology was used as a first step diagnostic procedure. This is the first study of its kind in Spain. Material was obtained from 660 patients, either from spontaneous nipple secretion or by fine needle aspiration. Cytologic criteria for recognition of the different cell types in the smears are discussed. The accuracy of the method was high (2.6% false negatives; 4.1% false positives). The cytologic technique for diagnosing breast lesions is simple, rapid and economic as well as harmless and painless. It therefore fulfills all requirements for an early diagnostic procedure.


Cytomorphologic study on the atypical cells following cryosurgery for the treatment of chronic cervicitis.

One hundred and twenty-nine patients of chronic cervicitis were treated by cryosurgery and periodically followed up by Pap smears and biopsies. Cytomorphologic studies were carried out on atypical cells following cryosurgery. Atypical cells were detected within four weeks. These were divided into two categories. The first group consisted of cells with abundant cytoplasm and occurred in sheets, aggregates and/or as isolated forms. Irregular nuclear borders were observed in 5.1 per cent and fine granular chromation pattern was found in 99.4 per cent. Irregular nucleolar borders were observed in 7.5 per cent and macronucleoli, over 2.5 microns in diameter, were disclosed in 11.3 per cent. Nuclei within 10 microns in diameter were observed in 56.6 per cent, and the maximum length was 20 microns. It was suggested that these cells were exfoliated from either basal cell hyperactivity or atypical reserve cell hyperplasia. The second group consisted of cells with scanty cytoplasm of bare nuclei and occurred in aggregates. Irregular nuclear borders were observed in 1.7 per cent and fine granular chromatin patterns were found in 99.7 per cent. Irregular nucleolar borders could not be encountered. Macronucleoli were observed in only 0.4 per cent. Nuclel within 10 microns in diameter were observed in 95.3 per cent and the maximum measured length was 15 microns. It was suggested that these cells could be derived from reserve cell hyperplasia or from immature squamous metaplasia. In conclusion, atypical cells following cryosurgery exfoliate from the regenerating tissue in which atypia is frequently observed. The cells of the first group have identical features with those observed in the cases of tissue repair; on the other hand, the cells of the second group were derived from reserve cell hyperplasia or from immature squamous metaplasia.


The cytodiagnosis of malignant lymphomas and Hodgkin's disease in cerebrospinal, pleural and ascitic fluids.

One hundred twenty-six fluids from 98 patients with malignant lymphomas have been examined cytologically. The overall accuracy was 88 per cent with only one false positive in 126 fluids. False negatives were highest in the cerebrospinal fluid, which may reflect poor exfoliation of malignant lymphoma cells when the leptomeninges are involved. We have found exfoliative cytology to be an accurate method of diagnosing lymphomatous involvement of the leptomeninges, pleura and peritoneum and when a cytologic diagnosis of involvement by lymphoma is made it is almost as accurate as a histologic diagnosis. Nuclear characteristics and selected histochemical methods will allow classification of many types of lymphoma in bytologic preparations.


Cytologic evaluation of the nasal epithelium in patients with hay fever.

Seventy two cases of hay fever which were confirmed by scratch tests were used to estimate the state of the epithelium of the mucous membrane of the nose. Cells of the respiratory eptihelium were found in smears from the surface of the mucous membrane in 79per cent of the cases of hay fever. Compared with nose smears from the control group, nose smears from patients with hay fever contained many more cells, predominantly goblet cells. In the cases of hay fever, a very rich cellular material was discovered in the smears from the surface of the mucous membrane of the nose. The chief characteristic feature of those cells is that they appear in clusters. Numerous cells from the respiratory epithelium, mostly goblet cells, were found in nose smears from patients with hay fever. The patterns of smears observed in patients with hay fever are helpful to us in the differential diagnosis in the rhinological laboratory.


Endometrial and endocervical brushing techniques with a Medhosa cannula.

A new technique for obtaining endometrial material using the Medhosa Cannula is described. This method is also useful to obtain samples from the endocervix. The Medhosa Cannula is made of flexible plastic. It is 30 cm long and has thin fins on its distal end which, guided by an introduction cone, permit endometrial and endocervical brushing. Six hundred cases are reported. Concomitant histopathological studies were performed in 40 per cent of the patients. There were two false negative cytologic reports (0.88%) and one false positive (6.66%). This is a simple, rapid, innocuous and economical technique, thus fulfilling the prerequisites for routine cytodiagnostic methods. Adequate material was always obtained.


The effect of phenobarbitone anaesthesia on blood flow and oxygen consumption in the rat brain.

The influence of phenobarbitone anesthesia on blood flow (CBF) and oxygen consumption (GMRO2) was evaluated in the rat brain, using a method that quantitatively measures CBF in mainly cortical areas. The data were compared to those obtained in animals under fentanyl citrate analgesia. Body temperature and arterial CO2 tension were maintained close to normal values in all groups. With 50 mg/kg of phenobarbitone, CBF and CMRO2 were reduced by about 20%. With 150 or 250 mg/kg, further reductions in CBF and CMRO2 were observed. At 250 mg/kg, CBF was reduced to one third, and CMRO2 to about 50% of normal. The results suggest that little further reduction in CBF or CMRO2 can be expected if the dose of phenobarbitone is increased above 250 mg/kg.


Cytologic findings in female and male offspring of DES treated mothers.

Data on vaginal, cervical, and endocervical samples and urine specimens of 84 female offspring exposed to diethylstilbestrol in utero and 43 controls have been presented. The colposcopic and histopathologic findings were correlated with the cytologic findings. Our preliminary findings indicate that the cytologic technique is reliable as screening test for vaginal epithelial changes in the DES-exposed females provided the sampling procedure is adequate. In 79 male patients, 42 DES-exposed and 37 controls, the pre-massage urine, the prostatic fluid, the post-massage urine and aspirate of cysts of the epididymis when existing were examined by cytologic techniques. No tumor cells were found in the cytologic specimens of the exposed and unexposed male and female offspring.


A simple technique for the determination of the ventilatory response to rising arterial CO2 tensions, suitable for patients with neurological disorders.

Patients with neurological disorders may have a reduced ventilatory response to a rising PaCO2. This is often unpredictable and may become apparent only when other complications, e.g. infections (pneumonia), occur or when the patient is subjected to general anaesthesia. This paper described a simple method suitable for screening patients who may have an impaired capacity of eliminating CO2 when stressed. Ventilatory changes were determined during the continuous recording of the CO2 concentration in end-tidal air in 20 healthy subjects, who were breathing first air and then gas mixtures containing 21% O2 and 2.5 or 5% CO2. A prediction interval with 90 and 95% probability limits was constructed for healthy individuals. The normally expected change in minute ventilation per m2 body surface area per change in PACO2 (delta versicle E/m2, l/min/delta PACO2, for this technique is also given.


A comparison between measured and calculated changes in the lung function after operation for pulmonary cancer.

Eighteen patients operated on for pulmonary cancer, the procedure varying from the removal of two segments to pneumonectomy, were subjected to measurement of the spirometric values VC, FEV1, FRC and RV preoperatively and 2-3 months postoperatively. The possibility of predicting the postoperative values from the number of segments removed was studied, partly with standard percentages (5.26%) per segment (method I), and partly with a percentage per segment in the affected area, calculated from the preoperative regional lung function tests using 133xenon. This latter test was carried out with a mobile apparatus using four detectors with tubular colimators and from the anterior surface of the thorax. Both methods of calculation gave, for the material as a whole, good agreement between the postoperative (measured) and the calculated values. However, with regard to certain patients, the regional lung function tests gave important information on preoperative reduced function in the affected area. In these patients, method No. II was by far the best for prediction of the postoperative values.


The use of 125I-labelled fibrinogen for determination of fibrin trapping in the lungs in patients developing the microembolism syndrome.

The microembolism syndrome occurred in four patients out of a series of 15 patients with multiple injuries who were considered to run a risk of developing this syndrome. These four patients showed signs of fibrin trapping in the lungs, as demonstrated by the use of 125I-labelled fibrinogen and external detection over the lungs. It is, therefore, considered that this method can be used for diagnosing the microembolism syndrome. The fibrin trapping occurred at the onset of the progressive respiratory insufficiency. The time relation between the uptake of fibrin and the onset of the progressive respiratory insufficiency supports the theory of a causal connection between fibrin and pulmonary damage. Measurements of different coagulation and fibrinolysis factors in the blood were not able to discriminate between patients who developed the microembolism syndrome and those who did not.


Tricyclic antidepressive poisoning with special reference to cardiac complications.

Sixty-eight cases of tricyclic antidepressive (TCA) poisoning are discussed. Cardiac arrest occurred in 8 patients, preceded by minor ECG-abnormalities. Five patients died. All cardiac arrests arose within the first 24 h after TCA ingestion. Fifty-seven patients developed ECG-abnormalities, of which 84% began within the first 6 h after TCA ingestion. ECG-abnormalities and other symptoms (respiratory arrest, coma, convulsion and hypotension) often occurred in the same patients. Treatment is described, and cardiac monitoring for at least the first 24 h is recommended. In cases of severe cardiac (ECG) abnormalities, monitoring is recommended until no ECG abnormalities are observed for at least 12 h. In conclusion, the unrestricted use of TCA is cautioned against, since TCA must be regarded as potentially cardiotoxic.


Patient material in multidisciplinary intensive care units.

The patient material in the multidisciplinary intensive care unit of Uppsala University Hospital is compared with the material from a recently performed nation-wide study on different intensive care units. A registration chart to record intensive care work and a time and motion study of nursing personnel are presented. It is concluded that such records are necessary to allow valid comparisons of the need for intensive care beds and personnel in hospitals of different sizes and degrees of specialization.


Treatment of pre-eclampsia and eclampsia as a hypoperfusion syndrome.

A therapeutical program in pre-eclampsia and eclampsia is presented. The results in 10 patients suggest that the same basic program as is used in the hypoperfusion syndrome can be used in pre-eclampsia and eclampsia: Chlorpromazin to combat vasoconstriction and dilate the vascular bed. Plasma expanders, plasma, albumin and glucose with electrolytes to fill up the dilated vascular bed and restore the tissue perfusion. Buffers to combat acidosis, oxygen to combat hypoxemia, hypertonic Mannitol to mobilize edema. Furosemide to force diuresis.


Prevention of hypertensive crises in patients with high spinal lesions during cystoscopy and lithotripsy.

Three patients with high spinal lesions, admitted to the hospital for cystoscopy and lithotripsy, showed signs of severe hypertension due to mass reflex during this operation. This symptom was controlled with an intravenous drip of Arfonade¿, and the patients felt quite comfortable without any other anaesthesia. Other possibilities for handling such patients are discussed.


The effect of anesthesia on intraoperative and postoperative bleeding during abdominal prostatectomies: a comparison of neurolept anesthesia, halothane anesthesia and epidural anesthesia.

Intraoperative blood loss was measured during abdominal prostatectomies in 213 patients anesthetized with neurolept anesthesia, halothane anesthesia and epidural anesthesia. In 55 of these patients, postoperative bleeding was also measured. The average intraoperative blood loss with neurolept anesthesia was 8.2 +/- 5 ml/min, with halothane anesthesia 6.6 +/- 6.3 ml/min and with epidural anesthesia 3.8 +/- 2.3 ml/min. The difference of blood loss in the epidural group and in the groups receiving general anesthesia is highly significant. Average systolic and diastolic blood pressures were lower during operation in the epidural group than in the other two groups. Statistical analyses failed, however, to show a significant correlation between blood pressures and blood loss in the individual patient. Thus, the ultimate explanation for the diminished bleeding associated with epidural anesthesia is not definitely ascertained. The average postoperative bleeding was not significantly different among the three anesthetic groups.


Extrinsic nervous control of the ileo-cecal sphincter in the cat.

The influence on the ileo-cecal sphincter (ICS) of electrical efferent stimulation of the splanchnic, lumbar colonic and vagal nerves and of intestinal distension was studied in anesthetized cats. A new flow-recording technique was designed. Reponses in the ICS to stimulation were recorded as changes in the transsphincteric flow. The response in the ICS was compared to the responses in the intestine proximal and distal to the sphincter. Sympathomimetic amines and autonomic blocking drugs were used in order to elucidate the autonomic mechanism by which the responses to stimulation were mediated. On the basis of the observations made the following conclusions were drawn: 1. Both the splanchnic and the lumbar colonic nerves exert a contractile influence on the ICS. The effect is mediated via excitatory adrenergic alpha-receptors. 2. The ICS contains inhibitory adrenergic beta-receptors. 3. Activation of the vagal nerves causes a decrease of the transsphincteric flow which is at least partly due to a direct nervous effect on the sphincteric muscle. A cholinergic mechanism is suggested. 4. Intestinal distension elicits contraction of the ICS. This excitatory intestino-ileo-cecal sphincteric reflex is a spinal reflex and mediated via adrenergic fibres within the sympathetic nervous system acting on alpha-receptors.


Psychiatric morbidity in Berlevåg.

For the population of Berlevåg the psychiatric morbidity is 37.3% registered with the Harvard health and family life survey and 20.5% with clinical estimates (life prevalence). The actual psychiatric morbidity (point prevalence) is assumed to be markably less than 20%. By checking psychiatric cases seen by the public health officer in the first half of 1973 and by 2 psychiatrists during field work the summer of 1974, the morbidity not registered yet, predominantly consists of borderline neurotic states, who by many psychiatrists will be considered as being within the limits of normal variation.


Preorthodontic guidance and the corrective mixed-dentition treatment concept.

A concept of corrective orthodontic treatment starting at an earlier age than usual has been discussed and illustrated. Realignment of terminology has been prosposed to give a clearer picture of the circumstance of malocclusion and its need for correction at an early age. A group of 300 patients treated in three categories were compared as to length of treatment time. Three groups of twenty-five patients treated correctively after preorthodontic guidance in the mixed dentition and only in permanent dentition were analyzed cephalometrically. The following conclusions can be reached: 1. Corective mixed-detition orthodontic treatment is a valid, safe, and reliable peocedure. 2. It encompasses both preorthodontic guidance and full-banded orthodontic treatment. 3. Current terminology is confusing and controversial...


Orthopedic effect of the extraoral chin cup appliance on the mandible.

An anatomic photoelastic model of a human skull was constructed with the use of individual simulants for teeth, bone, and periodontal ligaments. The following effects of extraoral chin cup traction were observed: 1. Stresses were noted in the area of the pterygoid plates of the sphenoid bone due to the insertion of the simulated external pterygoid muscle. 2. Because of direct contact of the condyle against the posterior surface of the glenoid fossa, forces were seen to be transmitted to this anatomic area. 3. Stress trajectories followed the trabecular pattern of the anatomic configuration of the mandible. 4. Beginning at the apices of the incisor teeth, the stresses emanated through the body, the angle and retromolar triangle of the mandible, radiating in a posterosuperior fashion and concentrating at the neck of the condyle. 5. Selected sectioning of the mandibular model showed evidence of stress concentration at the lingual aspect of the angle and retromolar area as well as at the condylar neck at the level of the external pterygoid muscle insertion. The effects of orthopedic forces produced by an extraoral chin cup in this study are correlated with the histologic and clinical observations during the utilization of this appliance in the treatment of Class III malocclusion.


Oral hygiene in the orthodontic practice: Motivation, responsibilities, and concepts.

This article describes our current oral health program. This program will continue to change as we learn more effective ways to communicate and offer instruction. The orthodontist and his staff are in a unique position to help patients become concerned about oral health. The cumulative effect of such patient educations is tremendous since hundreds of patients can be affected. Improving the effectiveness of an oral health program is an excellent opportunity to expand our service as health-care practitioners. A survey of dental home-care programs shows that a relationship exists between dentists' attitudes toward their programs and the degrees of success. Usually an oral health program will not become effective unless the orthodontist is motivated and accepts responsibility for motivating his staff and patients. The extent to which an orthodontist is enthusiastic and involves himself in oral health motivation will be reflected in how enthusiastic his auxiliaries are when instructing patients. If an orthodontist delegates both the motivational and instructional aspects of oral hygiene improvement to auxiliaries, his program will fall short of its potential effectiveness. A comment at each appointment telling the patient about his cleaning effectiveness is especially helpful. This feedback should be offered with kindness, objectivity, and respect for the patient. If an orthodontist feels impatient or frustrated, the patient will perceive this; perception of this negativity will frequently result in patient resistance to instruction and cooperation. When an orthodontist offers guidance in oral hygiene with sincere interest and respect, patients usually respond to his concern and become receptive to improving themselves. The extent to which we recognize a patient's "potential" to achieve excellent oral health, regardless of his present condition, will affect our ability to motivate that person. Our respect for patients will increase when we accept that nearly every patient has the inner capability for achieving excellent oral health. We have an opportunity to help patients recognize this potential. When patients recognize more of their potential, self-respect grows and they gain interest in caring for themselves.


Clinical treatment with the Begg appliance.

In a series of three articles, clinical treatment with the Begg appliance has been discussed. In the March, 1973 article, the standard procedures in the three stages commonly used in the Begg method were illustrated in a series of eight cases showing the wide range of orthodontic treatment possibilities of this method. The February, 1974 article contained a case report that illustrated some of the problems connected with orthodontic observation, diagnosis, Begg treatment, and retention. In this third article, due attention has been given to common problems of the chairside worker as encountered in daily practice. Certain comments have been offered, particularly with regard to child dental care and orthodontic guidance procedures of the growing child. A treatment approach, based on an individual optimum for each patient is discussed, following the course of treatment of three cases (Figs. 1, 2, and 4) with unfavorable jaw patterns and dental problems. These are compared with others having better anatomic proportions (Figs. 3 and 5). In the last case (Fig. 5) diagnosis and treatment planning are once again reviewed. The essential decision to be made for each orthodontic treatment, namely, whether and which teeth must be removed, is discussed and illustrated. In all cases, attention has been given to the portrayal of methods and technical details through the three stages of Begg treatment.


The role of fibroblasts in the remodeling of periodontal ligament during physiologic tooth movement.

Our findings indicate a cellular basis for the connective tissue remodeling which takes place during physiologic tooth movement. This cell is the fibroblast which is capable of synthesizing and degrading collagen simultaneously and, utilizing this ability, the orderly control of collagen remodeling within the periodontal ligament is possible. It is suggested that this cellular basis of connective remodeling will have a direct significance for orthodontic tooth movement once control mechanisms have been established.


Second premolar serial extraction.

Serial extraction of mandibular second premolars should be considered if they are impacted or in cases with moderate arch length deficiency combined with an absence of dentofacial protrusion. The favorable dental changes associated with this approach greatly minimize future orthodontic treatment complexity and time.


Phillip Gett memorial lecture awareness in anaesthesia.

An attempt is made to assess the importance of awareness and dreaming in patients subjected to light anaesthesia with muscle relaxants. Frank awareness is probably an uncommon event if the anaesthetic be given competently, but unpleasant dreams can, in some circumstances, be significant.


Low-output syndrome as a complication of open-heart surgery in 85 patients.

Low-output syndrome (LOS) was manifested after cardiopulmonary bypass in 33% of the patients undergoing mitral valve replacement in 12% of those submitted to aortic valve surgery, and in 16% of the patients on whom coronary artery bypass surgery was performed. It was also a frequent complication of multiple valve procedures, LOS was the commonest cause of hospital deaths after valve or coronary bypass surgery. The development and prognosis of LOS is dependent on several factors which may be related to the preoperative state, intraoperative events and postoperative treatment. Of these, one of the most important prognostic factors that emerged in this study was perfusion time. It was longest in the group of the 14 patients who died of myocardial failure on the operating table, shortest amongst the 28 patients who survived LOS, and of intermediate length for the 43 patients who died of LOS postoperatively. The differences between the groups were statistically significant. The mechanism of myocardial injury is reviewed. The incidence of various extracardiac complications increased during th postoperative course in proportion to the duration of LOS. Many of these complications resulted in a fatal outcome even when the patient was succesfully weaned from inotropic pharmacological support. There was more survivors in the group treated with dopamine than in the groups treated with isoproterenol or a combination of these drugs.


Ameloblastic fibroma. Case report.

A rare odontogenic tumour, ameloblastic fibroma, is presented as a case report and briefly discussed.


Facial pain.

The problems of diagnosis of pain are examined and the more important extra-oral causes which may complicate the diagnosis are discussed. The need for a complete and careful history and the use of thorough examination procedures is stressed in order that intra-oral causes may be eliminated.


Time of natural exfoliation of deciduous teeth.

Over 6000 naturally exfoliated deciduous teeth were sent in to the Department of Preventive Dentistry, University of Sydney over a 10-year period 1964-1974. Adequate histories for 2,828 teeth from 1,558 children were used to determine average ages of children at time of exfoliation of the teeth. Teeth lost at an earlier age were most frequently returned with similar numbers of left and right teeth. There were no differences in exfoliation times for corresponding teeth from left and right sides of arches. Girls had earlier exfoliation times than boys and lower teeth were generally exfoliated prior to upper teeth.


Histological studies of an adhesive paint-on restorative for cervical erosions.

A histological study of the response in the pulps of human teeth to cervical restorations made with a composite resin following etching of the enamel for 2 minutes with 50 per cent phosphoric acid showed moderate inflammation after 14 days. Three specimens showed normal structure after 98 days. Teeth restored without etching showed only slight inflammation.


Comparison of impact strength of joints made with four dental cements.

Tests on 4 cements showed the impact strength of joints between gold and tooth structure varied somewhat with the surface roughness and cementing force. Polycarboxylate provided stronger joints although the results were variable. Little difference was found between zinc phosphate, zinc oxide-eugenol with polymethyl methacrylate, and zinc oxide-eugenol with ortho ethoxybenzoic acid.


Infective endocarditis in a Sydney teaching hospital--1962-1971.

This report represents a comprehensive review of infective endocarditis in a major Australian centre between the years 1962 and 1971. During the later years of this study prosthetic valves were inserted in significant numbers and cardiac surgery became available in the treatment of endocarditis. The following major points emerged. There has been no reduction in the incidence of this disease within the period of study. A higher percentage of cases have followed surgery, particularly cardiac. There has been a decreased number of cases following dental extraction or urological surgery. A change in the pattern of the infective organisms was observed, particularly an increase in Staphylococcal infections, although Strep. viridans was the most frequent infecting agent. Infected prosthetic valves accounted for 11% of cases in the latter five year period, Staphylococcal infections being responsible for the majority of these cases. The mortality for prosthetic infections was 80%, and a loss of anticoagulant control contributed to death in 42% of patients. There was a reduction in mortality due to endocarditis from 39% between 1962 and 1966 to 24% between 1967 and 1971 (P less than 0-05).


Haemodynamic effect of intravenous verapamil in controlled atrial fibrillation.

The haemodynamic effect of intravenous verapamil was assessed in eight digitalised patients with atrial fibrillation, at rest and on exercise. The reported regularisation of the ventricular rate in atrial fibrillation with verapamil, was also examined. The only significant haemodynamic effect attributable to the drug was an increased stroke volume which was in accordance with significant heart rate slowing which occurred at rest and both during and after exercise. There was no significant change in cardiac output. Although the heart rate slowed in all studies, regularisation of the R-R interval did not occur.


The bone marrow colony forming cell in megaloblastic anaemia and iron deficiency anaemia.

Bone marrow samples from patients with megaloblastosis and iron deficiency have been assayed for their content of in vitro colony forming cells (CFC), and compared with a group of normal patients. The concentration of these cells was found to be significantly increased in the megaloblastic group, while their content in the iron deficient patients was slightly higher than the controls. An in vitro thymidine suicide procedures was utilised to assay the proportion of CFC in the S phase of the cycle. This was found to be increased in the megaloblastic group and only slightly increased in the iron deficient group. The findings in megaloblastosis seem to be consistent with the concept of impaired DNA synthesis. As the CFC monitors an early granulocytic progenitor these data suggest some impairment in DNA synthesis or an abnormal increase in amplification in this myeloid stem cell compartment. Such alterations in granulopoietic proliferation may contribute to the ineffective granulopoiesis of megaloblastosis and accordingly may be an important factor in the development of neutropenia sometimes associated with this condition. The slightly increased CFC concentration and altered cell cycle status found in iron deficiency suggest that iron is not a major requirement for granulopoiesis.


Inhibition of intestinal amino acid absorption by unconjugated bile salt in vivo.

The intestinal absorption of five amino acids studied (L-lysine, L-glycine, L-leucine and L-tyrosine) and one dipeptide (glycylglycine) was significantly inhibited by the deconjugated bile salt, sodium deoxycholate, in rats in vivo. It is suggested that inhibition of absorption of amino acids and dipeptides by unconjugated bile salts may contribute to hypoproteinaemia in patients with the contaminated small-bowel syndrome.


T4 thyrotoxicosis with normal or low serum T3 concentration.

Eight patients are described with elevated plasma thyroxine (T4) concentrations, but normal or low plasma triiodothyronine (T3) concentrations by radioimmunoassay. All were suffering also from non-thyroidal illness, which in six cases was severe, and in two fatal. The two patients in reasonable general health were acromegalic. It is possible that in sick thyrotoxic patients there is an impairment of peripheral conversion of T4 to T3, similar to that occurring in sick euthyroid patients. However, further proof of thyrotoxicosis must be obtained in patients with high T4 and normal or low T3 levels by studying the response of the pituitary to TRH. Meanwhile, in the sick or elderly, estimation of serum or plasma T3 concentration may not be a good screening test for thyrotoxicosis.


Acinetobacter anitratus infections in man.

During a period of 17 months, 142 strains of Acinetobacter anitratus were isolated from 140 patients. They were examined for biochemical characteristics, antibiotic susceptibilities to 15 chemotherapeutic drugs and clinical and epidemiologic features. Biochemical studies were necessary for positive identification of this gram negative rod. Many isolates were susceptible to kanamycin, gentamicin, polymixin B, cotrimoxazole and nalidixic acid. Most isolates were hospital acquired and had been cultured from a number of anatomic sites in the presence of a variety of clinical situations. Acinetobacter anitratus was the primary infecting organism in two cases of septicaemia (one fatal), two pneumonias, two wound infections and six urinary tract infections. Because of its potential pathogenicity this organism should not be dismissed as a harmless commensal by laboratory staff and clinicians.


Adenine phosphoribosyltransferase deficiency: its inheritance and occurrence in a female with gout and renal disease.

A deficiency of adenine phosphoribosyltransferase (APRT) enzyme activity to approximately 40% of normal has been found in erythrocytes from a young woman aged 24 years, who had suffered from recurrent gouty arthritis since 11 years of age. She also demonstrated considerable, although asymptomatic, renal impairment with a creatinine clearance of one-third normal. Her father had suffered from gouty arthritis but had a normal APRT activity; he was obese, had a high purine intake and was a regular beer drinker. The patient's mother was asymptomatic with a normal serum urate concentration, but demonstrated a similar reduction in APRT activity to that of her daughter. Eleven other asymptomatic members of the family also demonstrated a similar reduction in APRT activity in erythrocyte lysates. The pattern of inheritance was consistent with autosomal transmission. Concentrations of phosphoribosylpyrophospate (PRPP) in erythrocytes were within normal limits both in the subjects with deficient, and in those with normal, APRT activity. Partial purification of APRT enzyme from erythrocytes of the index case did not reveal any difference from the normal enzyme as far as Michaelis constants, heat stability, or mobility in polyacrylamide gel was concerned. No primary abnormality of lipoprotein metabolism was demonstrated either in the propositus or in other members of her family. Study of urate metabolism in the propositus indicated that, although urate production was within the normal range in absolute terms, there was increased incorporation of glycine into produced urate, usually taken as one index of de novo urate production. Impaired renal excretion of urate was also shown. Although detailed study of urate metabolism has not been undertaken in other family members with APRT deficiency, no conclusive relationship has yet been demonstrated between APRT deficiency and disordered urate metabolism.


Pyelo-ureteritis cystica associated with a urinary tract infection due to a coagulase-negative staphylococcus.

A young female presenting with a history suggestive of renal colic was found by intravenous pyelography to have Pyeloureteritis Cystica. In association with this condition she had a urinary tract infection due to a coagulase-negative staphylococcus. Following a two week course of appropriate antibiotic therapy, her urine became sterile and repeat pyelography revealed no abnormality.


Epidemic polyarthritis: a cytological, virological and immunochemical study.

A patient with epidemic polyarthritis was studied within 48 hours of onset when specific serum antibodies were still low. The synovial fluid showed a fall in hyaluronic acid level and rise in protein levels though the immune globulins, and especially IgM, rose to a lesser degree and remained well below the levels in the serum. Attempts to grow virus from synovial fluid or blood lymphocytes failed despite the use of several new techniques. The complement components C'3 and C'4 were not depleted in serum or synovial fluid. The synovial fluid was devoid of neutrophil leucocytes, and contained predominantly monocytes and macrophages which were remarkable for mitotic and for enhanced and indiscriminate phagocytic activity. From this and other evidence, an explanation is proposed for the cytological response and difficulties in recovering infective virions in virus-induced arthritis. No virus antigen was detected in the supernatant synovial fluid and electron microscopy showed virus-like particles only in cytolysosomes.


Rational therapy for thyroid storm.

An approach to the management of patients with thyroid storm is described. The treatment regimen, which is directed against the abnormalities as they are presently understood, incorporates: (a) Propranolol to inhibit the catecholamine-mediated peripheral effects of the circulating thyronines; (b) Propylthiouracil to inhibit thyroid hormone synthesis and to inhibit peripheral conversion of thyroxine to triiodothyronine (T3), the predominant source of T3 production; (c) Iodine to block the glandular release of thyroid hormones; (d) Dexamethasone along with general supportive therapy. The regimen has been used for a 13 year old schoolgirl with thyroid storm, and the induced rapid fall in serum T3 levels is illustrated. It has also been used in patients with florid thyrotoxicosis undergoing emergency surgery and has resulted in marked clinical improvement associated with rapid decreases in serum T3 levels. It is a simple and efficient regimen, rendering cumbersome forms of therapy such as plasmapheresis and peritoneal dialysis unnecessary.


Decreased capacity to metabolize diphenylhydantoin in a patient with hypersensitivity to warfarin.

A 48 year old man with normal hepatic function presented with abnormally prolonged bleeding following orally administered warfarin. Warfarin and diphenylhydantoin are known to be hydroxylated in the liver. To investigate the possibility of the patient having a metabolic (hydroxylating) defect, his ability to metabolize diphenylhydantoin was studied, as it would have been unethical to administer warfarin again. Parallel studies were carried out on two healthy subjects as a basis for comparison. On three separate occasions the elimination half-life for diphenylhydantoin in the patient (158, 87, 72 hours) was significantly longer than those obtained in the normal subjects (31 and 32 hours). This difference was most probably due to decreased hydroxylation of diphenylhydantoin to 5-(p-hydroxy-phenyl)-5-phenylhydantoin since his urinary elimination of this substance was demonstrated to be significantly less than that of the normal subjects. The results suggest that this patient had a reduced capacity to hydroxylate diphenylhydantoin, and this defect in liver hydroxylation may explain his increased sensitivity to warfarin.


Candida thyroiditis--treated with 5 fluoro-cytosine.

A case of Candida thyroiditis in a patient with Goodpasture's Syndrome is described. Factors predisposing to the infection were neutropenia and the concomitant use of antibiotics and immunosuppressive agents. The patient was successfully treated with 5 fluoro-cytosine (5 f-c) and surgical drainage.


Synchronous combined abdomino- thoraco-cervical (oesophagectomy).

A synchronous combined abdomino-thoraco-cervical oesophagectomy with an abdominal and a thoracic team working simultaneously, is advocated. The method is described. The necessity for wide excision of the oesophagus is stressed, and the routine use of the stomach for reconstruction is advised. This approach may be used for both benign and malignant conditions.


Early gastric carcinoma.

Seven cases of early gastric carcinoma are reported. This condition by definition refers to a carcinoma confined to the mucosa and submucosa only. The definition depends upon the depth of spread and not the surface area covered by tumour or the period over which it is believed to have been present. Each patient had a history indistinguishable from one of benign ulceration. All seven patients had barium meal studies, and in only two was the possibility of malignancy raised. In the other five patients the ulcers demonstrated radiologically were considered benign. Fibreoptic endoscopy was done in six cases; in three the appearances were suspicious of malignancy, and in the remaining three the lesions appeared benign. Biopsy specimens taken at endoscopy contained carcinomatous tissue in all six cases. The patients all had partial gastrectomy, and no recurrence has yet been found. The longest follow-up period is 36 months.


Large-bowel polypectomy via the colonoscope: experience with 80 polyps.

The experience of two colonoscopy units in managing 88 patients referred with 114 suspected colonic polyps are presented. Almost a quarter of the suspected polyps were artefacts, while some actual polyps were not visualized at the initial colonoscopy. All but 10 of the confirmed polyps were successfully snared. Morbidity was low. Five of the polyps were malignant. The technical aspect of snaring and of setting up colonoscopy units are discussed. It is considered that colonoscopic polypectomy is the optimum management of colonic polyps.


A major advance in the management of pneumatosis coli.

A new treatment for gas cysts of the large bowel is described which involves the continuous inhalation of a high concentration of oxygen over a five-day period. Two patients with incapacitating symptoms due to diffuse pneumatosis coli were treated by this method. Oxygen therapy resulted in remission of symptoms and disappearance of cysts in both cases. The physiological basis of this simple, effective therapy is discussed, together with the precautions necessary in its use.


Ileocaecal tuberculosis.

A retrospective study of 92 cases of ileocaecal tuberculosis, carried out at the Institute Hospital, New Delhi, is reported. The maximum incidence of the disease appeared to be between the ages of 20 and 40 years. There were 57 females and 35 males in the series. The majority of patients had symptoms for more than a year before they presented for treatment. Varying grades of intestianl obstruction constituted the usual clinical presentation, 44% of patients having subacute and 16% acute intestinal obstruction. Perianal fistula and abscesses were not seen. Most patients had no evidence of pulmonary tuberculosis. Barium X-ray studies were very helpful in the diagnosis. Bowel resection or short-circuiting gave very satisfactory results.


Hiatal hernia repair by posterior gastropexy.

Posterior gastropexy was used in the repair of seventy-seven hiatal hermias from 1970 to 1975, after the fashion of Lucius D. Hill, of Seattle. The operations were performed by one author and reviewed by the other. The rationale and technique of the operation are discussed. Ten patients were lost to follow-up. Fifty-six patients were greatly imporved or cured, ten were imporved but still had some symptoms, while only one was unimproved. We conclude that posterior gastropexy is an effective, simple, and safe operation for the treatment of reflux associated with hiatal hernia.