MIND--a five-state regional approach to continuing dental education.

MIND has finished two years of operation as a regional center for continuing dental education. The responses from viewing cards, and the number of credit hours given, indicate that approximately 20% of the potential audience participated in the course offerings. Previous experience from a two-year study in South Dakota has shown that there are three major factors that are essential for effective use of television as a dissemination medium. These are as follows: 1) the program should establish effective use of the communication system to maintain an audience; 2) the quality of thr programming material that is televised must be high; 3) the program should be televised on a regular basis to develop viewer habits or expectations. With a potential audience of 11,000 persons, MIND has had to depend heavily on a bulk-rate mailing system to communicate with members of the dental profession. This has caused problems such as reminders not being received on time, or being lost in the mail, or not being read, so that the individual is unaware that the courses are being telecast. Another problem of mailing system is maintaining an up-to-date list of addresses. The names and addresses of the dental assistants are impossible to keep up to date. We use the lists of licensed dentists and dental hygienists issued each July and a list of the certified dental assistants, which, of course, does not include all the dental assistants in our five-state area. A system providing more direct contact with the individual needs to be developed. Quality of televised courses is determined by the clinician's style of presentation as well as by the content and organization of the course material. The selection of dental information aimed toward the dentist in general practice results in loss of some members of the viewing audience, particularly specialists and generalpractitioners who have confined their practice to a particular area of dentistry. Quality is also judged by the technical aspects such as camera coverage, color, types of audiovisual materials, and televison reception. There is a limited amount of videotaped material available, and the members of the Board of Directors are asked to preview the videotapes and select three courses that they judge to be of the best quality for the year's programs. One difficulty is to find courses that will be of value to all three groups--dentists, dental assistants, and dental hygienists. Despite the problems encountered, the use of educational television should focus on the positive characteristics of availability, relatively low cost of operation, and the opportunity to provide continuing dental education at a convenient time and place.


A survey of extramural experiences for dental students.

A survey was conducted of the chairmen of the departments of community dentistry (or an equivalent department) within all full-curriculum dental schools in the United States as of September 1973, to obtain information on the rane of extramural experiences, the departmental responsibilities for these experiences, the times and the distributions of the experiences, and on feedback related to the experiences. Thirty-six respondents reported a wide variety of experiences with most activities under the auspices of departments of community dentistry. A trend toward concentration of the extramural experiences in the latter years of the curriculum was noted. Feedback from both the participating dental students and the patients was mostly positive to strongly positive. Most responding chairmen agreed that the extramural experiences may be helping to create a more socially conscious graduate, although few had conducted formal evaluations of the programs which could support this impression.


Plastic replicas as three-dimensional models of pulps.

It has been found that the plastic models significantly enhance the student's knowledge of the anatomy of teeth as it relates to operative dentistry. The fact that the models are three-dimensional eliminates guesswork as to the exact position of the pulp, and the rigidity of the plastic cast enhances the recovery of morphological features of the pulp as it existed in the natural tooth.


Practical considerations of a flexible course in a nonflexible curriculum.

In the context in which this course was conducted, i.e., flexibility within an otherwise rigid curriculum, and no deadlines, several conclusions can be drawn: 1. Students used considerably more time than when the course was traditionally structured. 2. Quality of performance in the preclinical laboratory was significantly better. 3. Students took longer to complete the laboratory requirements than didactic requirements. 4. Some reasonable deadlines are necessary. 5. Student and instructor attitudes favored flexibility.


Financial record-keeping simulation in the dental auxiliary utilization clinic.

A financial record-keeping and billing simulation program which is part of the Dental Auxiliary Utilization (DAU) didactic and clinical experiences has been reported. Evaluation of student performance has demonstrated a satisfactory level of accomplishment. The students' performance may reflect their awareness regarding the importance of understanding the management of the financial affairs of a dental practice.


Human pulp response to acid pretreatment of dentin and to composite restoration.

The newer composites, although free of methacrylic acid and of a neutral pH, were still found to be toxic to the pulp. The intensity of response was increased after acid pretreatment procedures; this indicates an increase in dentin permeability. When the remaining dentin thickness was 1.0 mm or less, regardless of whether the dentin was primary dentin or primary and reparative dentin, the percentage of teeth with abscess formations increased. Use of calcium hydroxide bases or liners to coat the dentin before acid pretreatment of enamel is therefore highly recommended.


New light on the transmissibility of viral hepatitis in dental practice and its control.

Evidence of an increase in the nonparenteral spread of viral hepatitis is of much concern in dentistry and supports the need for sterilization of all instruments used in intraoral treatments. Methods for the rapid sterilization of all dental handpieces and air-water syringes are still inadequate for routine clinical use. It may be possible to improve surface disinfection of these items by more thorough, repeated cleansing with common disinfectants and by the use of stronger germicidal agents such as aldehydes. However, for handpieces and some other equipment, effective sterilization methods must be developed or the instruments must be modified so they can be safely and rapidly sterilized. Surface disinfectants that will destroy hepatitis viruses are needed for disinfection of the dental unit. The use of gloves is also an important consideration for the protection of both the dentist and his patient. The high attack rate of hepatitis among surgeons, as well as patient protection, make the wearing of gloves during surgery imperative. Evidence that aerosolborne viruses would be removed by filtered laminar air flow or by face masks is not available, but use of these devices reduces exposure of personnel to aerosols in general and appears to be highly desirable. Sterilization of all possible instruments is advocated for use in all institutions and dental offices. Careful monitoring of the effectiveness of sterilization also is advocated. These concepts and new information on which they are based should be incorporated into dental curriculums and continuing education courses for all dentists and auxiliary personnel.


A quantitative comparison of services performed for fee-for-service and capitation patients.

The numbers of specific services performed for fee-for-service and capitation patients were compared in a group dental practice. The capitation patients received more services per 100 patients in almost all categories. This is attributed to the incentives for the dentist and a lower out-of-pocket cost for the patient.


Dental caries after radiotherapy of the oral regions.

Five cases of dental caries after radiation therapy of the oral regions for treatment of carcinomas are presented. The differences in clinical appearance and behavior between radiation caries and ordinary smooth-surface dental caries are described. The role of salivary gland irradiation and the resultant xerostomia in the development of these lesions is discussed. Some explanations are offered as to how these lesions develop in the light of current knowledge concerning plaque and the development of dental caries. Several measures that may be taken to reduce the incidence and severity of these lesions are suggested.


Laboratory and clinical evaluation of the radiation-potentiating activity of ethyl-N-bis (2,2-dimethylethylamidinophosphoro) carbamate (AB-132).

Ethyl-N-bis (2,2-dimethylethylamidinophosphoro) carbamate (AB-132) has been shown to potentiate the effect of whole-body radiation on inhibition of splenomegaly induced by Friend leukemia virus in ICR/H Swiss mice. The combined effect of AB-132 and radiation does not appear to be related to Friend virus inhibition but seems to act on the proliferating tumor in the spleen. Nine children with advanced cancer were treated with combined administration of local radiation and systemic AB-132. Although regression of tumor was seem, no dramatic effect on survival was apparent. One case of metastatic Ewing's sarcoma showed systemic tumor response to AB-132 in addition to localized response to radiation. Bone marrow depression appeared to be the main side effect of combination therapy.


Loss with age in the capacity for erythrogenin production by extrarenal tissues in rats.

Erythrogenin levels in liver and spleen were compared in young and adult anephric rats exposed to 6h of hypoxia. Hepatic and splenic erythrogenin levels in young nephrectomized rats were significantly higher than those in anephric adults. This lowered ability of the adult rat to elaborate extrarenal erythrogenin may be related to a decrease in selective enzyme production which accompanies the aging process.


Implanted amniotic membrane as an autograft and as an allograft.

Detailed studies on autograft and allograft amniotic membranes implanted in the subcutaneous tissues to form tunnels are described. Autograft amniotic membranes appear to become permanent structures whereas allografts of this material, though accepted by the host for a longer time than most allografts, were eventually rejected. Serial histological studies were performed.


Effect of N6-(delta2-isopentenyl)adenosine treatment in vivo on hexokinase activity of mouse L 1210 cells.

The kinetic properties of hexokinase of L1210 ascites tumor cells propagated in DBA/2HaD mice are altered by treatment of the mice with the modified nucleoside N6-(delta2-isopentenyl)-adensone (IPA). Relative to animals not treated with IPA, ascites cell hexokinase showed an increased affinity for ATP and a decreased affinity for glucose as a result of IPA treatment. The heat stability of the enzyme was different in treated and untreated mice. It was concluded that IPA treatment may either produce changes in enzyme conformation which resulted in a change in control mechanisms or may induce the formation of a hexokinase isoenzyme.


The significance of lymphocytosis in congenital hypoplastic anemia.

Two infants with congenital hypoplastic anemia had an unusual number of lymphocytes in their peripheral blood and in the bone marrow. This caused an erroneous diagnosis of acute lymphocytic leukemia to be made in the first case and inappropriate therapy to be administered for three months. The second of these cases provided an unusual opportunity to study human erythrocyte precursor dynamics. Serial bone marrow aspirates, obtained after institution of treatment with a corticosteroid, revealed an initial increase in labeled lymphocytes, a concomitant decrease in their number, and the subsequent appearance of erythroid elements. These findings suggest that cells classified morphologically as lymphocytes may serve as erythroid precursors in human beings.


Results following three modalities of periodontal therapy.

Three methods for treatment of periodontal pockets (subgingival curettage, modified Widman flap surgery, and pocket elimination) were applied as a clinical trial to 82 patients. Follow up results over one to five years after the initial treatment are reported. The variations in attachment levels and pocket depth were analyzed statistically as related to methods of treatment and yearly time intervals following the initial treatment. The most favorable results regarding gain or maintenance of attachment levels and reduction of pocket depth were observed interproximally. Subgingival curettage provided the greatest gain in attachment level up to three years postoperatively, but after four to five years there was no significant difference in results following the three methods. The most significant loss of attachment and return of pocket depth occurred on the buccal aspects of the teeth, and the results were not significantly different for the three methods except at the first year of follow up when the attachment level was maintained best after curettage.


Mucogingival problems, prevalence and therapy in children.

The clinical impressions of the authors and a survey of mucogingival problems in children lead to the following conclusions: 1. Mucogingival problems occur in children. 2. The prevalence of such problems is 12 to 19% in sample of 100 patients examined. 3. Insufficient keratinized tissue is developmentally related to: a. eruption pattern of the permanent incisors. b. buccolingual width of the alveolar process. 4. The autogenous free gingival graft is recommended as an acceptable procedure to prevent incipient mucogingival problems from progressing. 5. Where orthodontic therapy is anticipated and coincidentally insufficient keratinized tissue exists, a free gingival graft should be performed prior to tooth movement. 6. Grafts would be recommended in children with 1 mm or less of keratinized tissue. 7. Grafts would not be recommended in children when there is over 2 mm of keratinized tissue. 8. Grafts would not be recommended in children with greater than 1 mm of attached gingiva.


Occlusal characteristics and tooth mobility in periodontally healthy young males classified orthodontically.

Three groups of periodontally healthy young males classified as to orthodontic status by the Handicapping Labio-Lingual Deviations Index were evaluated for various occlusal characteristics. A much larger proportion (95%) of the orthodontically normal subjects (Group I) had an Angle Class I type of occlusion than the Group II subjects requiring orthodontic care (60.5%), or the Group III subjects who had received orthodontic care (63.4%). The percentages of subjects with a "cuspid-protected" type of occlusion were larger in the orthodontically normal and orthodontically treated groups than in the group requiring orthodontic care. Anterior displacement of the mandible in closing from centric relation to the intercuspal position was found in the majority of subjects in each group. Displacement of more than 2 mm was most common in the subjects requiring orthodontic care. Only 1 of the 41 orthodontically treated subjects reported that his occlusion had been adjusted by grinding after tooth movement. There were no statistically significant differences in mean tooth mobility values between the orthodontically normal and orthodontically treated subjects. The lateral incisor tooth had a significantly lower mean mobility value in subjects whose orthodontic care included removal of the first premolar than in subjects treated without removal of the first premolar. Wear facets were common in all three groups. Based on the findings, one can conclude that orthodontic therapy was only partially successful in obtaining the objectives described as part of an ideal result. It should be noted, however, that the status of the dentition and occlusion prior to orthodontic treatment could not be determined for more than a few subjects.


Periodontosis: a problem in orthodontics.

1. Periodontosis occurs in the same age group in which orthodontic therapy is most often done. It is a periodontal disease which in the early stages may show little or no gingival inflammation and is easily overlooked unless one is aware of the existence of this condition and looks for it. 2. Since malocclusions are common in adolescents, it is reasonable to expect that some adolescents with malocclusions will also develop periodontosis. 3. Periodontosis may have its onset during active orthodontic treatment. 4. Orthodontists, should routinely examine all of their patients, using adequate roentgenograms and a periodontal probe before initiating therapy and at periodic (yearly) intervals during active treatment. 5. Where malocclusions are present in patients who already have periodontosis, orthodontic treatment may be a necessary and beneficial part of the total treatment plan.


Human lymphoproliferative reaction to food products. Possible role in periodontal inflammation.

Extracts of corn and some nuts were found to ubiquitously stimulate both adult and newborn cord blood lymphocytes to transform and produce a factor chemotactic for monocytes. This indicates that corn and nuts contain a mitogen and are potential stimulators of the cellular immune response. The exposure of lymphocytes to this mitogen in vivo might trigger a destructive inflammatory reaction in the surrounding tissues. These findings, therefore, suggest that foods such as corn and nuts may be responsible for some periodontal abscesses and may be contributing factors to the development of intrabony alveolar lesions and chronic periodontitis.


Salivary alterations in diabetes mellitus.

Separately collected parotid and submaxillary salivary samples from 20 diabetic and 20 matched control subjects were analyzed for flow rate, electrolyte content and immunoglobulin (IgA, IgG and IgM) levels. Flow rates did not vary significantly between the two groups of subjects; calcium ion content, however, was higher in the diabetic subjects for both salivary glands. The presence of salivary IgI in 6 of 10 patients was also a significant finding. Any attempt to draw a conclusion between the severity of periodontal disease and Diabetes Mellitus from the above findings is still speculative but does indicate further areas of research.


Synthesis and biological activities of some N6-(nitro- and -aminobenzyl)adenosines.

Synthesis and biological activities of 12 analogs of N6-benzyladenosine are described. The compounds were prepared by two methods: (1) direct alkylation of adenosine with an appropriately substituted benzyl bromide to give the N1-substituted derivative which was then rearranged in base to give the N6-substituted compound, and (2) by nucleophilic displacement of chlorine in 6-chloropurine ribonucleoside, 6-chloro-2-aminopurine ribonucleoside, and 6-chloro-2-aminopurine with an amine. These analogs were examined for their growth inhibitory effect in cultured leukemic cells and also for their effect on adenosine aminohydrolase activity. N6-p-Nitrobenzyladenosine and its 2'-deoxy analog were competitive inhibitors (K1 65, 22 MUM). The 2-amino-N6-p-nitrobenzyladenine and its ribonucleoside were found to be noncompetitive inhibitors of adenosine aminohydrolase. In cultured L1210 leukemia, 2-amino-6-p-nitrobenzylaminopurine and the corresponding ribonucleoside were better growth inhibitors than N6-benzyladenosine, while N6-p-nitrobenzyladenosine, its 2'-deoxy analog, and N6-p-fluorobenzyladenosine were as active as N6-benzyladenosine.


Inhibition of leukocyte migration by tumor-associated antigens in soluble extracts of human malignant melanoma.

Direct leukocyte migration inhibition (LMI) assays were performed to investigate whether cell-mediated immune reactions could be detected in response to tumor-associated antigens of human melanoma. The antigens were 3 M KCl-soluble extracts of different fresh melanomas, other cancers, and benign nevus tissue. A total of 48 of the 79 (61%) blood samples from melanoma patients (64 patients) reacted with extracts of melanoma tissue. Since the subjects were usually tested with two or three extracts, 57/134 (42%) tests with melanoma patients' leukocytes were inhibited by KCl extracts of melanoma tissue, whereas only 3/50 (6%) tests with leukocytes of normal donors and 4/27 (15%) with patients having other cancers gave positive results. No positive reactions were obtained when 13 melanoma patients were tested with a 3 M KCl extract of benign nevus tissue. Likewise, only 2/26 (8%) positive tests were obtained from melanoma patients tested with extracts of other cancers. Individuals in all stages of disease had similar incidences of positive reactions to the soluble melanoma extracts, except for patients with stage-1 disease who exhibited a somewhat higher incidence of reactivity. The highest incidence of reactivity was observed in patients before surgical resection of the tumor, and somewhat decreased reactivity was seen 0-14 days post surgery. The results indicate that the direct LMI assay may be used to measure cell immune reactivity against melanoma-associated antigens. Since many of the positive results were obtained with allogeneic extracts, the results also indicate that different melanomas possess common antigens.


Antiserum against leukemia cell ferritin as a diagnostic tool for malignant neoplasms.

The specific antiserum against a type of ferritin that is especially common to leukemia cells and the placenta was used to test, by countercurrent immunoelectrophoresis, sera from humans with various diseases. The best results were obtained with leukemia; patients with chronic myelogenous leukemia in blastic phase, acute myelogenous leukemia, lymphogenous leukemia, and unclassifiable juvenile leukemia frequently showed a positive reaction, but patients with chronic myelogenous leukemia in static phase did not. The average incidence of positive reaction among all leukemia patients was 54.0%. Patients with other malignant tumors (i.e., multiple myeloma, malignant lymphoma and carcinomas of the stomach, rectum, and liver) also often showed a positive reaction. The average incidence of positive reaction among all the patients with malignant diseases of the hematopoietic system, except for leukemia, was 34.3%, and that among patients with nonhematologic malignant neoplasms was 36.8%. However, the incidence of a positive reaction in patients with benign diseases and healthy individuals was less than 3%.


Electroencephalographic and other neurophysiological abnormalities in uremia.

1) Neurophysiological abnormalities in patients with renal failure are being investigated because a) it is the nervous system which preeminently produces the phenomena of clinical uremia that dialysis affects and b) objective quantitative measures of such functions are generally lacking and are needed to provide objective evidence for adequacy of dialysis and other treatment measures in uremic patients. Accordingly, the attempt is warranted to measure in objective terms what renal failure, alternatively maintenance dialysis, does to the patient's nervous system in the comprehensive terms and the several modalities by which the nervous system serves the patient. 2) It is clear from the foregoing presentation that electroencephalographic phenomena including some aspects of the spontaneous EEG and certain event-related potentials can be readily reduced to quantitative terms. Some of these are abnormal in the presence of renal failure, are improved by dialysis treatment, may vary with the frequency of dialysis treatment and are often normalized by renal transplantation. Apparently similar EEG changes may be induced by other intercurrent influences occasionally operating in patients with renal failure. These can usually be readily detected but appear at this time to limit the potential usefulness of the EEG in those instances. However, especially using successive determinations in individual patients, the quantitative measure of slow-wave-associated EEG power is a reasonable candidate-measure of adequacy of dialysis. Other measures should be explored. 3) Quantitative measures of EEG phenomena appear to be superior in speed and objectivity to conventional, descriptive reporting of electroencephalograms, especially for the repetitive comparisons which are necessary for clinical patient monitoring. 4) The data system so far employed to transform EEG phenomena into clinically useful data (Fig. 1) will be greatly simplified as soon as the most informative, sensitive and specific measures are selected from among those being explored. Dedicated micro-processing equipment, for example, can then be expected to replace the much more expensive, multipurpose computer system which is necessary for the initial investigation.


Neurobehavioral dysfunction in uremia.

To summarize our concepts relating to impaired function of the mind in uremic patients before and during treatment with maintenance dialysis, the emphasis had gradually shifted from the use of "static taxonomy", the diagnostic labels of mental illness, to a more dynamic and sympathetic appreciation that the observed behaviors represent patients' attempts to cope with disease and threats of disability and death, as influenced by varying levels of intelligence, education, cultural conditioning, life experiences and organization of personality defense mechanisms. The dialysis patient is aware that his behavior evokes reciprocal and complicating responses from important people in his environment. These interactions are perceived and conducted by neurochemical mechanisms of the brain which may be impaired in the abnormal chemical environment imposed by renal failure. It is the behaviors we perceive as indicators of disordered nervous mechanisms. Therefore, it is logical that neurobehavioral phenomena should be measured quantitatively in order 1) to estimate objectively the patients' success in achieving the goal of maintenance dialysis treatment, 2) to assess the comparative adequacy of dialysis regimens and 3) to provide objective end-point measures which are relevant to uremia for further investigations of the etiology and pathogenesis of these critically significant uremic manifestations. Our experimental results using ipsitive cognition performance tasks clearly suggest that discrete human performances may be evoked and employed to detect mentational impairments of uremia in quantitative terms, a fundamental step having central relevance to what dialysis does in controlling uremic symptoms.


Recommendations for evaluation of the cardiovascular response of dialysis patients.

The minimum parameters, which I have stressed in the first section, should be measured at least once a week, as should the chest films, the films of the vessels and so on, plus the chemistries, probably when determined by the investigator. If we are going to compare program to program, these intervals should, of course, be synchronized. The more sophisticated parameters, which I have mentioned, should be measured perhaps only when specific areas are to be investigated because the number of things which we think need to be measured is, indeed, enormous for any one laboratory. Now, if such studies are to be carried out by a number of investigators, the standard form mentioned should be instituted and yearly meetings of such groups should be held to compare notes, and particularly the adequacy of the data obtained and the method of obtaining it. Initially perhaps, after the program is underway, if enough groups are actively involved, the first meeting probably should be held six months after the beginning of the evaluation. I realize what we have put forth here is ambitious. I think it is probably wise to put in as many things as possible which might be important, and then with a little rethinking time, obviously some of these things can be eliminated. To my knowledge, we have covered almost everything that needs to be covered, and what we need to do now, perhaps, is to thin this out a little bit with discussion and consultation.


Neurotoxicity in uremia.

The dialysis patient is aware that his behavior evokes reciprocal and complicating responses from important people in his environment. These interactions are perceived and conducted by neurochemical mechanisms which may be impaired in the abnormal chemical environment imposed in renal failure. It is the behaviors we comprehend as indicators of disordered nervous mechanisms. Therefore, it is logical that neurophysiological and neurobehavioral phenomena should be measured quantitatively in order 1) to estimate objectively the patients' success in achieving the goal of maintenance dialysis treatment, 2) to assess the comparative adequacy of dialysis regimens and 3) to provide objective endpoint measures which are relevant to uremia for further investigations of the etiology and pathogenesis of these critically significant uremic manifestations. Our experimental results illustrate that: 1) measures of conduction velocity, distal latency and response amplitudes, as employed by us, were relatively insensitive in the patients and circumstances studied; 2) several neurophysiological measures, i.e., the spontaneous EEG, VER latency and, perhaps, photic stimulation, on the other hand, are highly correlated with the severity of renal failure; 3) behavioral measures of sustained attention and alertness (TMT), of short-term memory (ASTM) and of cognitive manipulation of symbols (AR) are also highly correlated with the severity of renal failure; 4) some measured abnormalities improve following dialysis, but not always to normal--three residual impairments may indicate dialysis in adequacy; 5) several of these measures can provide objective evidence for adequacy of dialysis and other clinical and treatment effects in patients with renal failure.


[Acute lymphoblastic leukemia after tuberculosis in a 8-year old greek boy with homozygous beta-thalassemia (author's transl)].

A greek boy is described in whom pulmonary tuberculosis and homozygous beta-thalassemia was discovered at 4 years of age. Tuberculosis was cured after 1 year of combined tuberculostatic chemotherapy. His thalassemia only required 1-2 blood transfusions per year. Acute lymphoblastic leukemia was diagnosed in the patient at 8 years of age and treated with antileukemic combination chemotherapy and cranial irradiation. 7 months after diagnosis the boy is still in continuous complete remission under antileukemic chemotherapy without requiring blood transfusions.


Modern trends in human genetics.

Every physician is deeply concerned with the tremendous advances in genetics during the last decade. Through 'gene surgery' DNA transplantation on both somatic and germinal tissue is feasible. Thus, genetic determinism is no longer ineluctable. Tissue culture is a tool to avoid cellular degeneration and achieve cellular immortality.Precise chromosome identification allows one to follow transmission from generation to generation, as well as human gene mapping. Through clinical and especially biochemical methods, genetic entities are dissected more accurately. Ecological genetics studies the risk inherent with drugs, radiations, chemicals and a myriad of environmental factors. On the other hand, behavioral genetics tend to specify the part of the genetic set in human behaviour. Computerized programmes are responsible for some significant advances in population genetics. Prenatal diagnosis, newborn screening programmes, heterozygote detection, and so on, and add a new dimension to genetic counseling. Knowing the part of inheritance in retinal affections, our speciality will greatly benefit from these recent advances in genetics.


Ligand-induced redistribution of lymphocyte membrane ganglioside GM1.

Dynamic aspects of the binding of cholera toxin to lymphocyte membranes have been studied. We have shown that the receptor for this ligand--the GM1 ganglioside--can be laterally redistributed into aggregates and caps. Exogenous purified GM1 inserted into GM1-deficient human leukaemic cells can undergo a similar pattern of ligand-induced mobilisation. These observations may have important implications for both the general behaviour of cell surface glycolipids and the mode of action of cholera toxin on adenyl cyclase.


The adequacy of outpatient child psychiatric facilities?

An analysis was made of South Auckland cases referred to the Auckland child health clinic in 1972 and 1973, and a survey of the views of the doctors and others who refer to the clinic was undertaken. The aim of the study was to establish whether the child assessment and treatment needs of the South Auckland area are being met, and the conclusion of the authors was that they are not. Recommendations are made.


Normal radiological renal size: simple estimation from single urogram series.

A normal range of kidney size can be defined from a single, technically adequate, excretory urogram series. Relation of kidney length to distance between L1 to L3 bodies inclusive gives a better indication of normal size, than comparison between kidney length and a single vertebra. The span of the normal range of kidney length to lumbar spine ratio is such that its application to a given radiological examination will be of marginal value.


Prophylactic antibiotics in open heart surgery.

Two prophylactic antibiotic regimes were compared in 129 patients who had open heart surgery for mitral and/or aortic valve replacements at Guy's Hospital. The first group were prescribed cephalothin for five days beginning with premedication. The second group were prescribed the combination of cloxacillin and gentamicin for the same time. The incidence of minor infection was low. There was no statistical difference between the two antibiotic regimes. The major infections were due predominantly to Gram negative organisms and difficult to prevent by any prophylactic regime.


Lung cancer diagnosis: evaluation of diagnostic techniques.

In 200 patients with histologically proven lung cancer, retrospective analysis of the relative diagnostic value of sputum cytology, bronchial washings cytology, bronchial biopsy, scalene node biopsy, mediastinoscopy and thoracotomy was undertaken. Bronchial biopsy proved positive in 80 percent of patients with central tumours (those lying between the origin of a main brochus and the origins of lobar segmental bronchi) against 35 percent of patients with peripheral tumours (those lying distal to the origins of the lobar segmental bronchi). Sputum cytology was positive in 27 percent of patients so investigated and bronchial washings cytology in 14 percent--both techniques being more effective with central tumours. Thoracotomy, as the sole method of obtaining histological confirmation of the clinical diagnosis, accounted for 20.5 percent of all cases, being used more often in patients with peripheral tumours. In 15 percent the first histologically positive result came from distal spread. The relative indications for needle biopsy and endobronchial fibroscopy are discussed.


Unwanted corticosteroid effects in childhood bone marrow failure, renal failure and brain damage: case report.

The case report of the corticosteroid complication in an eight-year-old girl with immune thrombocytopenic purpura is presented. She was treated with high dosage corticosteroids and incurred severe side effects, including bone marrow depression, renal magnesium stones, osteoporosis, depression of affect, convulsions with cerebral damage and adrenal suppression.


Christchurch traffic trauma survey: Part 2, victims and statistics.

The results of a survey carried out at Christchurch Hospital examining the problem of traffic trauma are described. The majority of casualties were in the 15-24 age group and motorcyclists were especially prominent. The type and severity of injuries is discussed for each role, e.g., driver, passenger etc. The availability and use of safety equipment (seat belts and crash helmets) by the victims who came to hospital is also detailed. Accidents were found to occur predominantly (88 percent) in urban areas and very close to the victim's home.


Estimation of maximal oxygen uptake in New Zealanders of three age groups.

An assessment of cardiorespiratory fitness has been made in New Zealanders of both sexes, in three age groups. Three separate methods were used to predict maximal oxygen uptake (VO2 max) from observations during submaximal exercise on a bicycle ergometer. The nomogram of Astrand was inappropriate for the prediction of VO2 max in most groups: extrapolation of the submaximal data gave values essentially in agreement with those calculated from the formula of von Dobeln, Astrand, Bergstrom (1967). Mean VO2 max of each of the male groups was 40.31 ml/kg (adults); 43.54 ml/kg (university students) and 52.92 ml/kg (secondary school students). Corresponding values for females were 38.91 ml/kg, 46.64ml/kg and 42.87ml/kg. These values put young New Zealanders into a low fitness category compared with populations studied in Norway, Sweden, Japan, USA, Britain, Peru and Canada.


Antimicrobial resistance in urinary tract infections.

In this investigation Gram negative bacilli resistant to two or more antibiotics were isolated from 120 individuals with urinary tract infection. Antibiotic sensitivity patterns were determined by the Kirby-Bauer paper disc method and by an agar-plate-dilution method capable of measuring the minimum inhibitory concentration at the level of antibiotic attainable in the renal interstitium and urine. The results have shown that with selected antibiotics up to 75 percent of the isolates resistant by standard disc procedures are sensitive at concentrations of antibiotic readily attainable in the urine. The implications of these results in relation to the therapy of urinary tract infection have been discussed and evidence presented that the determination of the minimum inhibitory concentration of selected antibiotics may be of considerable value in the management of urinary tract infections.


Treatment of anorexia nervosa.

Anorexia nervosa is a well-known syndrome occurring predominantly in adolescent girls, and characterised by amenorrhoea and gross weight loss due to self-induced restriction of food intake. The prognosis is poor but full recovery does occur as illustrated by long-term follow-up of 22 unselected patients, eight of whom have recovered to date. A definite treatment programme is recommended as likely to improve the prognosis. This consists of hospital admission for restoration of normal weight, combined with family intervention and continuing long-term individual psychotherapy. The hospital regime for weight restoration involves bed rest, refeeding by experienced nursing staff, and a situation where the patient has no opportuinty for avoiding weight gain but receives constant reassurance. Under these conditions restoration of full normal weight is achieved, as illustrated by 14 admissions to hospital with only one failure to acheive target weight.


Soleus rupture: a differential diagnosis of calf thrombosis.

Soleus rupture may present with clinical features similar to those of calf thrombosis. It is postulated that the signs are the result of compression of the posterior tibial vein as it passes through the narrow space adjacent to the fibrous origin of soleus. A distinctive venographic sign of compression of the posterior tibial vein by a soft tissue mass at the level of the origin of the soleus is described.


Attitudes of the public to medical care: Part 5-Para-medical services.

A sample of the population of Auckland and Dunedin was asked a series of six questions concerning their attitude to para-medical services as provided by a Plunket nurse; a public health or school nurse; a district nurse; a medico-social worker from a hospital and the ambulance service. Analysis of the replies shows some differences in utilisation of specific services comparing one city to the other. Respondents' opinions on the methods of financing these services show a general vote for preservation of the status quo but with some increased Government support. These are indications that the public is unaware of current methods of financing such services. Public acceptance of the idea of employment of trained nurses and social workers in general practice was high and when the question was made more specific by referring to the respondent's own family doctor the acceptance was much higher. Reasons for non-acceptance do not indicate any major difficulties in the employment of such staff in general practice, at least as far as the patients are concerned.


Conjugated polyene fatty acids as membrane probes: preliminary characterization.

The use of fluorescent conjugated polyenoic fatty acids as probes of membrane structure is introduced. alpha- and beta-parinaric acid (cis, trans, trans, cis-, and all trans-9,11,13,15-octadecatetraenoic acid) and synthetic lecithins containing an alpha-parinaric acid chain in position 2 are prepared and their absorption and fluorescence properties are determined. Phase transitions are detected as fluorescence changes at characteristic temperatures when either the free fatty acid probes or the labeled phospholipid probe are included in sonicated aqueous dispersions of L-alpha-dimyristoyl lecithin, L-alpha dipalmitoyl lecithin, or L-alpha-distearoyl lecithin. The phase transitions are detected at about 23 degrees C (dimyristoyl), 44 degrees C (dipalmitoyl), and 53 degrees C (distearoyl lecithin). Binding of alpha-parinaric acid to bovine serum albumin is measured by shifts in the absorption spectrum and enhanced quantum yield of the fatty acid upon binding and by energy transfer between 2 tryptophyl residues in bovine serum albumin and alpha-parinaric acid. Approximately six binding sites are detected. Other applications of these probe molecules, including phase transitions of phospholipid/cholesterol dispersions, induced circular dichroism of parinaric acid bound to albumin, and biosynthetic incorporation of parinaric acid into biological membranes, are discussed.


Human gene expression in rodent cells after uptake of isolated metaphase chromosomes.

Permanent transfer of genetic information from chromosomes isolated from human diploid cells to recipient cells has been demonstrated. Human metaphase chromosomes were incubated with mouse A9 fibroblasts deficient in hypoxanthine phosphoribosyltransferase (IMP:pyrophosphate phosphoribosyltransferase, EC 2.4.2.8) and adenine phosphoribosyltransferase (AMP:pyrophosphate phosphoribosyltransferase, EC 2.4.2.7). Colonies of cells containing hypoxanthine phosphoribosyltransferase appeared during growth in a selective medium. The hypoxanthine phosphoribosyltransferase gene product in four independent colonies was identified as human donor species by both gel electrophoresis and isoelectric focusing; hence these colonies did not result from reversion of ta9 parental cells. Other X-linked human genes, glucose-6-phosphate dehydrogenase (D-glucose-6-phosphate:NAD(+) 1-oxidoreductase, EC 1.1.1.49) and phosphoglycerate kinase (ATP:3-phospho-D-glycerate 1-phosphotransferase, EC 2.7.2.3), were not expressed in these same colonies. Dissociation of expression of these X-linked genes probably results from chromosomal fragmentation during uptake, but other mechanisms have not been excluded.


Distribution and virogenic effects of 5-bromodeoxyuridine in synchronized rat embryo cells.

Rat embryo cell cultures were synchronized by a double thymidine block. The DNA replication phase (S) was divided into an early, middle, and late period. Cell cultures in the early, middle, or late S phase were pulsed with 0.1 muM 5-bromo[(3)H]deoxyuridine (BrdU) or equimolar [(3)H]dT. DNA-DNA reassociation experiments of each sample revealed that [(3)H]BrdU was more concentrated in the intermediate repetitive than the repetitive or unique DNA sequences of the early and middle S phase. In contrast, [(3)H]dT was nearly uniformly jistributed throughout all nucleotide sequences during the entire S phase. synchronized rat cells were pulsed during various portions of the S phase with unlabeled 0.1 mM or 0.1 muM BrdU and examined for sytoplasmic immumofluorescence against the 30,000 molecular weight group-specific antigen (p30) of Friend mouse leukemia virus. Equally strong fluorescence was detected 12 hr later in cells treated with each concentration of BrdU. Furthermore, incorporation of BrdU during late S phase was suffieient to elicit maximal antigen expression.


Coezyme A requirement of malaria parasites: effects of coenzyme A precursors on extracellular development in vitro of Plasmodium lophurae.

The extracellular development in vitro of the avian malaria Plasmodium lophurae is favored by addition to the medium of coenzyme A at 0.05 mM. Coenzyme A can be replaced by dephospho-coenzyme A and to some extent by phosphopantetheine, but not by phosphopantothenoylcysteine or by phosphopantothenic acid. The activity of the two former precursors results from their conversion to coenzyme A by enzymes in the erythrocyte extract of the culture medium in the presence of ATP, also an essential ingredient of the medium. Hence, P. lophurae in its erythrocytic stage has an absolute requirement for an exogenous source of coenzyme A.


Cell-division factors from Vinca rosca L. crown gall tumor tissue.

A cell-division factor has been precipitated from extracts of cultured Vinca rosea L. crown gall tumor tissue by using the mercuric acetate procedure previously employed by Wood and colleagues to obtain their "cytokinesin I." On the basis of its mass spectrum, ultraviolet light absorbancy spectra, solubilities, chromatographic migration values, and growth activity, the factor is ribosyl-trans-zeatin, that is, 6-(4-hydroxy-3-methyl-trans-2-butenylamino)-9-beta-D-ribofuranosylpurine. Ribosylzeatin has now been isolated from tumor tissue by four experimental techniques; any possibility that it is an artifact seems to have been eliminated. Contrary to the report by Wood and colleagues, synthetic ribosylzeatin is precipitated from an aqueous solution by mercuric acetate, provided the complete precipitation procedure is utilized. These facts and others discussed strongly support our suggestion that ribosylzeatin was present in the preparation ("cytokinesin I") examined by Wood and colleagues in several biological assays. The reasons advanced by Wood and others for rejecting this suggestion have been found either not to be pertinent to the question or to have insufficient experimental bases.


Relationship between sterol synthesis and DNA synthesis in phytohemagglutinin-stimulated mouse lymphocytes.

Incubation of peripheral blood or isolated lymphocytes of C57L/J mice with phytohemagglutinin stimulated the incorporation of thymidine into DNA of lymphocytes as they transformed into large lymphoblasts. DNA synthesis began after about 24 hr of incubation and reached a peak at 48 hours. The de-novo synthesis of sterols from acetate was stimulated much earlier, at 4 hr of incubation, and the rate reached a maximum at 24 hr, approximately at the time DNA synthesis began. Rates of incorporation of radioactivity from [14-C]acetate into fatty acids and into CO2 by phytohemagglutinin-treated blood were not significantly different from control values. Phytohemagglutinin stimulation of sterol synthesis could be abolished by the addition of certain oxygenated derivatives of cholesterol (e.g., 25-hydroxycholesterol and 20alpha-hydroxycholesterol) which specifically depress the activity of the regulatory enzyme in the sterol synthesis pathway, 3-hydroxy-3-methylglutaryl CoA reductase [mevalonate:NADP-nOXIDOREDUCTASE (CoA acylating); EC 1.1.1.34]. This treatment also abolished DNA synthesis and blastogenesis which otherwise followed the peak of sterol synthesis. Furthermore, DNA synthesis was repressed only if the inhibitor was added early enough to prevent sterol synthesis from reaching its usual maximum. When the compound was added after the rate of sterol synthesis had reached its maximum, DNA synthesis was not affected. These findings suggest that the synthesis of cholesterol is an essential prerequisite for successful initiation and completion of the cell cycle in lymphocytes after phytohemagglutinin activation.


Formation of cholinergic synapses between dissociated sympathetic neurons and skeletal myotubes of the rat in cell culture.

Sympathetic principal neurons, dissociated from superior cervical ganglia of newborn rats, were plated into cultures containing rat skeletal myotubes formed from previously plated primary myoblasts. Electrophysiological evidence is presented that the neurons developed cholinergic synapses with the myotubes. In addition, the neurons developed cholinergic synapses with each other as previously reported [O'Lague et al. (1974) Proc. Nat. Acad. Sci. USA 71, 3602-3606]. The acetylcholine receptors of myotubes differed from those of the neurons in their sensitivities to curare and hexamethonium, in a manner expected of adult muscle and ganglionic receptors. alpha-Bungarotoxin blocked synaptic transmission from neuron to myotube, but not from neuron to neuron in the same culture.


Gastric pathology produced by hypothalamic lesions in rats.

Rats made aphagic and adipsic by damage to the lateral hypothalamus develop gastric lesions and lose body weight excessively over a four day period. Control observations indicate that these effects cannot be accounted for by food and water deprivation or by operative trauma. The possibility that gastric lesions may contribute to aphagia or anorexia is discussed.


[Fibrous dysplasia and a cementofibroma in a child].

The authors present a case of odontogenic tumour occuring at birth. Its origin seems to be an early modification of the ectomesenchyme. The course of the disease may be followed by lines within the dentin traced by courses of tetracycline during the first few years of life.


[2 new methods of retention in sagittal osteotomy of the ascending ramus].

The authors present two techniques designed to ensure contact between the two bone cortical plates in sagittal osteotomy of the superior ramus of the mandible used in the correction of prognathia and retrognathia. The first technique requires the use of a special suture guide, designed to aid in steel wire osteosynthesis. The second involves a bolt fixed by a screw, the role of which is to keep the external cortex applied against the medial fragment.


[Prosthetic problems after excisional surgery].

The authors present a few cases maxillary and facial reconstruction with restoration of the esthetic appearance, mastication and phonation, using the obturator muscles and prostheses made up of acrylic resin and silicone elastomers.


[Abnormal inclinations of the alveolar process; incidence of total forms].

Statistics from 1500 orthodontic cases confirm the frequency of total clinical forms of inclination abnormalities of the alveolar processes. The results obtained emphasize the importance of teleradiography of the head in a vertical position, the X-rays being directed perpendicularly in the direction of the plane of bite of the molars, completing in a transverse direction the morphological examinations begun by teleradiographies of the side of the face.


Prolonged in vitro closure of the mouse secondary palate by salicylates.

In organ culture sodium salicylate and acetylsalicylic acid in a 1.4 mM concentration caused prolongation of the time needed for the closure of the mouse secondary palate. The response of Strain A and the hybrids CBA X A was more distinct than that of Strain CBA. The mitotic rate, calculated from serial sections, was significantly reduced in the salicylate-treated shelves in both strains. The extrapolation of the results to an in vivo situation is discussed in the light of different theories of the mechanism of cleft palate formation.


Dose and age dependent variations in effect of tetracycline on enamel formation in rat.

Incidence of rats with gross enamel lesions in response to tetracycline hydrochloride (TC) was studied in relationship to age, tooth type, and concentration of antibiotic in the injection fluid. Incidence was defined as percentage of animals with defects in at least one incisor or one molar. Serum levels were measured at various intervals in 4- and 75-day-old rats, which received a single i.p. injection with 130 mg/kg bw in concentrations of either 13 or 25 mg/ml saline. The study confirmed that the effect of TC on enamel varied with age of the animal and that the molar responded more readily than the incisor. Furthermore, the incidence was higher the higher the concentration of antibiotic. This effect appeared tied to a direct relationship between concentration and serum level. Serum levels declined more slowly in the younger than in the older rats, resulting in significantly higher levels 6, 24 and 48 h after dosing, which correlated with a more extensive labeling of the dentin in the young rats. The possible roles of serum levels, capillary supply and cell susceptibility are discussed in relation to differences in response with animal age, between tooth types, tooth surfaces and with age of the secretory cells.


Effect of oxytetracycline and purified calcein (DCAF) on the apposition and mineralization of rat incisor dentin.

Thirty male rats in groups of ten were given intraperitoneal injections of oxytetracycline and purified calcein (DCAF) every day for 10 d in order to determine whether these fluorescent hard tissue markers per se had any adverse effects on weight development and dentin apposition and mineralization. It was found that oxytetracycline and DCAF in doses of 15 mg/kg, which are the routine doses used by the author in hard tissue studies, do not seem to have any measurable influence on these parameters, while their ability to cause fluorescence is fully satisfying in dentin as well as in bone.


Clinical kinesthetic experiments on the lateral pterygoid muscle and temporomandibular joint in man.

The possible kinesthetic function of proprioceptors in the lateral pterygoid muscle was clinically assessed after anesthesia of muscle and temporomandibular joint receptors, respectively. A mandibular posture was actively and repetitively produced with an average accuracy of 2.5 mm, while the accuracy decreased by about two-fold after narcotization. It is suggested that muscle spindles in the lateral pterygoid muscle as well as mechanoreceptors in the temporomandibular joint capsule are active in the perception and/or control of mandibular postures.


Creep of dental amalgam.

The steady-state creep rates of dental amalgams were measured and the creep rates were correlated with the microstructure of the amalgams. The influence of manipulation variables on creep rate and microstructure are evaluated. The samples were either mechanically or hand triturated, hand condensed, and stored at 20 degrees C for 7 d. The specimens were subjected to a constant tensile load for 24 h, and the elongation was measured with a displacement transducer. The smallest creep rate was found on a spherical amalgam, and the highest on an amalgam made from a preamalgamated fine grain alloy. A correlation between microstructure and creep rate could be demonstrated. The amount of gamma2 phase did not seem to influence the creep rate. Amalgams that had large closely packed gamma particles surrounded by a small volume fraction of gamma1 phase exhibited a low creep rate. Amalgams that had small broken up gamma particles surrounded by a large volume fraction of gamma1 exhibited a high creep rate. Abusive manipulation of lathe-cut amalgam alloys resulted in high creep rates, small broken up gamma particles and a high volume fraction of gamma1.


Morphology of growing bone surfaces.

The relation between bone surface patterns and the rate of bone formation and destruction was studied by observing surface sections and ground sections. The material used consisted of the dried skulls of three pigs. Observations on surface sections revealed two prinicipal types of bone surface patterns, i.e. a type characterized by smoothness and regularity and a type characterized by roughness and irregularity. Observations on corresponding ground sections revealed that these patterns represent appositional surfaces and resorptive surfaces, respectively. Within each type of surface pattern, variations occurred. As judged from the corresponding ground section, these variations might express variations in growth rates.


Graded gastrectomy for duodenal ulcer -- a five-year prospective study.

One hundred and twelve consecutive patients selected for surgical treatment for duodenal ulcer disease were treated by a graded gastrectomy according to the Moynihan modification of the Billroth II partial gastrectomy. A large partial gastrectomy (R) (2/3-3/4 gastrectomy) was done in patients who after maximal stimulation with histamine showed a high acid output (MAO greater than 30 mEa/hr), and a small resection (r) (1/3-1/2 gastrectomy) in low secretors (MAO less than 30 mEq/hr). The material was prospectively controlled by admission to hospital at 3 months, 1 year and 5 years postoperatively. The preoperative values of MAO found in R and r were 42.8 and 21.5 mEq/hr (p less than 0.001), respectively. The postoperative MAO values at the 3-month control were 4.5 and 3.0 mEq/hr by R and r, respectively, which shows that the grading of resection had been successful. Atrophic gastritis increased in frequency from 4% at the time of operation to 72% at the 1-year control...


[The development of the filiform papillae in the human tongue].

Filiform papillae are described in a 4-month-old fetus, in premature children (22-36 weeks) and in children who died soon after birth. Under the scanning electron microscope papillae filiformes often displayed tubercles appearing either independently or arising near the base of the tongue from obliquely running ridges dividing afterwards into tubercles. Some SEM specimens showed further development of papillae from tubercles and cylindrical papillae into papillae quite similar to those found in a fully developed tongue. They were however significantly smaller. Filiform papillae are more varied in the stage of development than in the fully developed tongue, because developmental stages could be observed here. We could also see spheroid papillae with tiny processes on the top or large scales on the circumference besides the above mentioned formations. Even places with "hairs" resembling those of the hair-tongue were found. These atypical findings were most likely pathological changes resulting from hypoxia before death.


[The Centric relation. II. Volumetric variations during the mounting of models on the articulator].

When mounting models on the articulator there is some possibility of error due to the expansion of plaster during the setting period. If one does not pay attention to this expansion, one can observe an opening in between the arms of the articulator. In order to minimize expansion one must: -- increase the W/P ratio -- decrease the amount of plaster used for mounting the models The expansion modifies the reference plane and this is important only in case of remountings.


[The uptake of oxygen and glucose by the gingiva in diabetes mellitus with various forms of periodontal diseases].

Gingiva biopsy samples from healthy individuals and from diabetics with different forms of periodontal disease were incubated in the Warburg apparatus for 2 hours. Considerable reduction in oxygen consumption and glucose uptake was found in each type of periodontal disease, the most marked reduction being stated in case of parodontopathia dystrophica. The extent of the metabolic disturbance as well as the appearence of periodontal disease correlated with the duration of diabetes on the one hand with the frequency and severity of diabetic retinopathy on the other hand.


[A quantitative method for the measurement of the marginal space using Ca45].

A survey of the most known methods of testing for marginal fit is followed by the description of the determination of marginal leakage by means of autoradiography. 45Ca was used as a radioactive isotope. The most favourable times of penetration and exposure are indicated. Provided that certain standards are respected, the magnified autoradiograms may be measured and the values obtained can be used for comparisons. The applicability and the error range of the method were tested in 2 series of Super-Syntrex fillings.


[Electrophoretic study of serum proteins in patients with periodontal diseases].

Electrophoretic study of the serum proteins in individuals with periodontal disease. Total protein was determined in serum samples from 20 subjects affected with periodontal disease and from 20 healthy persons. In addition the authors performed paper chromatographic and immuno-electrophoretic studies. It was found that the relative ans also the absolute mean values for gamma globulins were significantly higher in the control group. In individuals affected with periodontal disease, an increase of all three immunoglobulins (i.e., IgA, IgG and IgM) was observed in 10 of 20 cases, whereas such an increase occurred but once in the control group. The increase in the immunoglobulin content of serum samples from individuals affected with periodontal disease is brought in relation to the inflammatory condition of the periodontium.


[Teleradiodiagnosis for players of brass instruments].

Teleradiodiagnostics as applied to brass instrument players. Specific diagnostic procedures are a great help in the stomatological care of wind instrument players. The authors summarize already confirmed radiological results which had been obtained from examinations of wind instrument players. Further teleradiodiagnostic possibilities are indicated, using lip representations in the cup of mouthpiece, tongue documentations and projections of the rim of mouthpiece on the subjacent structures. Their applicability to this occupational category is discussed.


[Stomatological morbidity study--Berlin 1972. 3. The frequency of dysgnathias and their symptoms in the subjects of an epidemiologic-stomatological study].

Stomatological morbidity study - Berlin 1972. Part III. The frequency of dysgnathias and their symptoms in subjects of an epidemiologic-stomatological study. In the course of a stomatological morbidity study which was performed in Berlin in 1972, the authors investigated the dental conditions of 657 subjects, having an age range from 18 to 30 years. Only 15.2% of the persons under investigation had an eugnathic dentition. Almost 85% of the individuals showed dysgnathias. Apart from the frequency of certain tooth malalignments and malocclusions, associated symptoms were recorded. 15.5 of the subjects under investigation said that they had had orthodontic treatment. Significant differences were found in comparing the results obtained from treated individuals with those from untreated subjects.


[Aims and methods of treatment in orthodontics].

The scope and the forms of treatment in orthodontics. On the occasion of the Symposium of the Society of Orthopaedic Stomatology of the German Democratic Republic at Reinhardsbrunn (Thuringia) from April 8 to 11, 1974, questions concerning the scope and the forms of treatment in orthodontics were dealt with in the framework of the main subject "The Effectiveness of Orthodontic Treatment in Adolescents". The present contribution was the discussion basis on the first day of the meeting. It is possible to substantiate the extent of normal biological, dentometric and cephalometric variations. The form of treatment should be an individual one, respecting the most favourable moment for treatment and well-tried therapeutical methods. Modifiable biological parameters should be adepted to unchangeable morphological and functional conditions. Broad-based, prevention-oriented orthodontics should be adhered to.


[Complex therapy].

Complex therapy. On the occasion of the Symposium of the Society of Orthopaedic Stomatology of the German Democratic Republic at Reinhardsbrunn (Thuringia) from April 8 to 11, 1974, questions of complex therapy were dealt with in the framework of the main subject "The Effectiveness of Orthodontic Treatment in Adolescents". The present contribution was the discussion basis on the second day of the meeting.


Incidence of glycogen storage disease in the German Federal Republic.

100 cases of GSD were traced in the GFR.  The overall incidence is 1:113000 in proportion to live births.  Type I occurs most frequently with 30%, followed by Type II and Type VI with 20% each.  Type III is extremely rate in the GFR.  5 cases were classified as glycogenosis with the Fanconi syndrome.  With the exception of Type III the type distribution in the GFR was similar to that found in 316 cases in a diagnostic center in Belgium.


[Granulocytic sarcoma of the breast in chronic granulocytic leukemia (author's transl)].

A 46 year old women with long lasting menstruation disturbances and amenorrhea developed a chronic granulocytic leukemia and bilateral mammary tumors after pregnancy.  The histologic examination revealed a myelosarcoma of the breast.  The diagnostic features and the pathogenesis of these tumors are discussed.  The severe hormonal disturbances could be accepted as localizing factors.


Cytologic studies on so-called atypical epithelium of the protuberant lesions in the stomach.

Cytologic studies based on the observation of 32 atypical epithelial growths from 31 patients revealed the following characteristics: (1) The nuclei were usually elongated. The mean size of the major axis of the nuclei was most frequently distributed in the range of from 14 to 17mu while the mean size of the minor axis was between 6 and 10mu. (2) The chromatins of the nuclei were fine and showed even to somewhat dense distribution. The nucleolus was inconspicuous. (3) The cells were heaped together. A cellular aggregation was clearly composed of smaller groups of cells in which the polarity of nuclear arrangement was well preserved. Some cells at the periphery of a cellular aggregation were arranged radially toward the outside. The cells were usually cohesive, but in severe grade of atypism, they sometimes showed a scattering tendency. (4) The cells of atypical epithelium seemed to be very insensitive to radiation, compared with carcinoma cells of the stomach.


Prevention of meningeal  leukaemia and relapses by cranial irradiation and intrathecal MTX in acute lymphatic leukaemia.

Experience with CNS prophylaxis in 35 children with acute lymphatic leukaemia is reported. Before prophylactic irradiation of the skull was given the average survival time in 36 children was 2,8 (2,7) years. Menigeal leukaemia preceeded bone marrow relapse in 9 cases and followed relapse in a further 5 cases (39%). Between 1971 and 1973 Pinkel's treatment scheme VII was given to 35 children. This included prophylactic skull irradiation and intraspinal MTX injections. 29 children are still in their first remissions which range from 10 - 35 months in length. Meningeal leukaemia has not so far been observed, in this latter group.


Application of discrete computer modeling to the dynamics of cell populations.

Computer simulation of the dynamics of cell populations is discussed in the paper. Fundamental features of CELLSIM simulation language are described. Acute leukemia cell population model was implemented on a digital computer using CELLSIM. Some of the computer outputs are shown. The results obtained so far are interesting and promissing for further research.


Atypical progressive multifocal leukoencephalopathy with plasma-cell infiltrates.

In rare cases of progressive multifocal leukoencephalopathy (PML) the lesions are atypical in that the characteristic alteration of oligodendrocytic nuclei is infrequent or absent, and the demyelinated foci contain mononuclear inflammatory infiltrates including numerous plasma cells. Otherwise these cases, both as to the topographic features of the lesions, and the background of chronic lymphoproliferative or myeloproliferative disease or immunosuppressive treatment, conform to the usual pattern. In the case here reported, that of a 54-year-old man receiving immunosuppressive drugs for chronic polymyositis, electron microscopy showed papovavirions in astrocytic nuclei and fluorescent antibody studies indicated that these represented JC virus. In this and the 3 previously reported similar cases of atypical PML, the neurologic illness was less devastating than generally occurs in classic PML. Possibly these cases represent instances of unusually strong host-resistance against the disease.


[Effect of hydroxyurea treatment on free nucleotides in leukemic leukocytes].

An increase was observed in the pool of free nucleotides of leukaemic leucocytes during treatment with hydroxyurea, which was used as a drug inducing remission in chronic myeloid leukaemia and as an agent synchronizing the cell cycle in the so-called synchronization treatment of acute myeloid leukaemia. The increase in the amount of free nucleotides may depend on their increased synthesis and on their less extensive utilization for synthesis of nucleic acids. According to the authors the observed changes in the pool of free nucloetides may possess certain therapeutic implications.


SSPE-like inclusion body disorder in treated childhood leukemia.

Clinico-pathological report on a boy with cytostatically treated leukemia, dying with cerebral symptoms after passing clinical measles 10 weeks before death. At autopsy, numerous nuclear inclusion bodies in glial and nerve cells were found. By electron microscopy, nuclear inclusions appeared as loosely arranged smooth tubules, corresponding to paramyxovirus nucleocapsids. Frequently, cytoplasmic changes appeared too, consisting of incomplete tubular structures and an abundant dense "fuzzy" material. No regular tubuli of the coated granular type were present, as in common measles virus infection, nor any mature viral structures or differentiation of the surface membrane. The lack of maturation in cytoplasm together with a predominance of nuclear changes suggested a slow type of measles virus infection, while the particular cytoplasmic changes suggested a defect in synthesis of granular nucleocapsids, possibly a basic factor for the slow type of the viral infection. Possible pathogenetic factors are discussed.


A scanning electron microscopic study of 34 cases of acute granulocytic, myelomonocytic, monoblastic and histiocytic leukemia.

This report describes the surface architecture of leukemic cells, as seen by scanning electron microscopy in 34 patients with acute nonlymphoblastic leukemia. Six patients with myeloblastic, 4 with promyelocytic, 10 with myelomonocytic, 8 with monocytic, 4 with histiocytic and 2 with undifferentiated leukemia were studied. Under the scanning electron microscope most leukemia histiocytes and monocytes appeared similar and were characterized by the presence of large, well developed broad-based ruffled membranes or prominent raised ridge-like profiles, resembling ithis respect normal monocytes. Most cells from patients with acute promyelocytic or myeloblastic leukemia exhibited narrower ridge-like profiles whereas some showed ruffles or microvilli. Patients with myelomonocytic leukemia showed mixed populations of cells with ridge-like profiles and ruffled membranes whereas cells from two patients with undifferentiated leukemia had smooth surfaces, similar to those encountered in cells from patients with acute lymphoblastic leukemia. It appears that nonlymphoblastic and lymphoblastic leukemia cells (particularly histiocytes and monocytes) can frequently be distinquished on the basis of their surface architecture. The surface features of leukemic histiocytes and monocytes are similar, suggesting that they may belong to the same cell series. The monocytes seem to have characteristic surface features recognizable with the scanning electron microscope and differ from most cells from patients with acute granulocytic leukemia. Although overlap of surface features and misidentification can occur, scanning electron microscopy is a useful adjunct to other modes of microscopy in the study and diagnosis of acute leukemia.


The surgical uncovering and orthodontic positioning of unerupted maxillary canines.

1. The presence of the maxillary canine is vital to the function and esthetics of the dental complex. The availability of this tooth must be carefully considered during an orthodontic diagnosis. Lack of space is the most common cause of canine impaction. Other contributing factors are that this tooth has the longest period of developmenent and that it is bigger longer, and travels farther while erupting than any other tooth. 2. Proper management of unerupted canines is a challenge to the dental practitioner. Maxillary canines are found impacted to both the buccal and the lingual. Palatal impactions are much more common than labial impactions, but, of the two, labial impactions are more difficult to manage. 3. An appropriate surgical procedure which opens to the crowns of unerupted teeth is a key to uneventful orthodontic positioning of these teeth. Packing the follicular space with baseplate gutta-percha and keeping the crown open to the oral cavity with surgical WondrPak is an effective method of making the tooth erupt into the oral cavity. 4. Modern preformed bands and improved cements make the placement of attachment on malposed teeth relatively easy. Direct bonding techniques are also of value in the management of unerupted teeth. 5. It is practical to move teeth orthodontically from seemingly impossible positions into ideal alignment. Such teeth will function normally, and no evidence will be left of their original position or of their having been moved over long distances.


Clinical management of the mandibular molars.

The complex variety of clinical problems posed by the lower molars requires maximum care in diagnosis and in treatment planning. In this article several therapeutic solutions to these problems are presented. The need to treat positional anomalies of the second molars and to control their drifting in cases of bracing and mandibular insertion, may be an effective auxillary means of treatment of those malocclusions in which lengthening of the dental bracing zones is indicated.


On optimum orthodontic force theory as applied to canine retraction.

The study reported here was undertaken in an attempt to contribute, from a theoretical standpoint, to the knowledge and understanding of optimum force theory, particularly as it may be relevant to canine retraction. The following statements are derived from my analysis of the applicable published literature and the results of the present investigation: 1. This study lends support to the beliefs, from the findings of previous investigations, 20, 22 that the center of rotation for simple tipping is three tenths to four tenths of the distance from the root apex to the alveolar crest and that the center of resistance is at approximately midroot for the single-rooted tooth. 2. For a given distal driving force, increasing the countertipping couple from zero causes the center of rotation to "move" from a point near the apical end of the middle third of the root to the root apex and then to infinity. That is, the couple to be developed by the appliance to produce crown movement is smaller than required for bodily movement. Also, increasing the rotational stiffness of a canine-retraction appliance will result in greater inherent potential for canine root control and a greater probability of achieving bodily movement. 3. In a specific orthodontic case, an average periodontal stress value (active force divided by root area) can be used as a basis of comparison of suggested active force magnitudes among several single-rooted teeth having different root surface areas, provided all teeth are to experience the same form of displacement (for example, bodily movement). Similarly, differences in average stress magnitudes developed in the periodontium, rather than differences in root surface areas, are actually the basis for the differential force theory. 4. Clinical studies have suggested that the size of active force for bodily movement or root movement of a given tooth be two to three times that employed in simple tipping of the same tooth. Induced stress levels in the periodontium, especially at the root apex and alveolar crest locations, can be related to suggested magnitudes of aplied crown force components.


A modified technique for evaluating apical base relationships.

1. The ANB difference is not always an accurate method of establishing the actual amount of apical base divergence. In addition to the geometric shortcomings previously pointed out, the results of this study indicate that the ANB landmarks are subject to growth and treatment mechanics which cause corresponding variations in the measurements used. 2. The AXD method described in this study demonstrates a method of relating apical bases which eliminates two of the variables, nasion and point B. The AXD angle is a more critical evaluation and was found to correspond significantly with a linear measurement of the actual apical base difference. 3. This study and others have demonstrated conclusively that angular measurements cannot compensate for divergence of apical bases resulting from variations in vertical facial height. For this reason, a set of linear measurements was proposed which would offer an accurate method of evaluating the pre- and posttreatment changes taking place. 4. The linear measurements introduced in this study demonstrate an accurate method of assessing apical base relationships. The use of these measurements provides a critical evaluation of treatment and places proper emphasis on favorable growth and treatment mechanics. 5. The study of the pre- and posttreatment  linear measurement concerning point A determined that this landmark remained remarkably constant during orthodontic treatment. It would appear from this study that treatment mechanics for Class II cases do not actively relocate point A but actually hold it in position while the middle face is growing forward. 6. The A-D' measurement is concerned with the actual distance, in millimeters, between the apical base landmarks. In the fifty cases studied, the mean pretreatment measurement of A-D' was reduced 15.8 per cent as the Class II malocclusion was corrected. The mean pretreatment ANB underwent a reduction of 43.1 per cent on these same cases. While the A-D' pre- and posttreatment change may not be as dramatic as the ANB evaluation, the major point to consider is the critical degree of accuracy which this measurement brings into an analysis.


Effect of edgewise treatment and retention on manidbular incisors.

This study consisted of analyzing clinical records of fifty cases treated for correction of Class I malocclusion with varying degrees of bimaxillary protrusion and anterior mandibular crowding. Thrity of these cases required extraction of all four first premolars. Parameters characterizing changes in position of mandibular incisors during treatment with edgewise appliances and during retention and shortly afterward were studied. All the parameters indicated rather similar changes for the nonextraction and the extraction groups. The relapse of anterior mandibular crowding was significantly larger (p less than or equal to 0.05) in the nonextraction group. The IMPA and interincisal angle changed significantly more in the extraction group. Upon testing for validity of the mesiodistal to faciolingual indices, it was determined that they predicted stability of the achieved alignment of mandibular incisors. There were, however, individual cases in both groups which did not follow the central tendency. It was observed that the mesiodistal diameters of mandibular incisirs were somewhat larger in the extraction cases. There was only one pair of parameters that showed a moderately high intercorrelation (r equals 0.68); that was between correction of the anterior crowding and relapse of the intercanine expansion. It was observed that the more correction took place, the more readily expanded canines would relapse. An over-all impression is that the mandibular incisors change little in their position to each other and relative to the other structures of the mouth. The question remains: Is this due to our ability to control them well, or due to an inability to move and maintain them in their new position?


Drug evaluation of pyrantel pamoate against Ancylostoma, Toxocara, and Toxascaris in eleven dogs.

Eleven dogs dosed at approximately the recommended rate of 1.029 mg of pyrantel pamoate/kg of body weight were used. The efficacy against Ancylostoma in the 11 dogs was 99% (av; min-max, 94-99%). In 4 dogs with both Toxocara and Ancylostoma, average efficacy against Toxocara was 96%, and in 5 dogs with both Toxoscaris and Ancylostoma, efficacy against Toxascaris was 93%. Only 2 dogs of the 11 were infected with the 3 species; the average efficacy was 90%. There appeared to be no activity against the Trichuris found in one dog and the Dipylidium found in another. Treated dogs did not vomit or have other noticeable ill effects.


Synovial membrane and fluid morphologic alterations in early rheumatoid arthritis: microvascular injury and virus-like particles.

Eight patients have been studied during the first 6 weeks of rheumatoid synovitis. All of them exhibited microvascular injury, which was manifested by gaps between endothelial cells, vascular occlusion, erythrocyte extravasation, or endothelial cell injury. In four patients, a variety of virus-like particles were found associated with the endothelium or perivascular cells. In two cases, particles were seen in electron-dense deposits in vessel walls. Lymphocytes and PMN infiltrated the synovial membranes, but plasma cells were uncommon. Evidence of phagocytosis was prominent in synovial lining cells and other large mononuclear cells, but not in PMN. These observations are consistent with injury to synovium and, specifically, synovial vessels as an early stage in RA synovitis. The virus-like particles require further investigation, because nonviral cell components remain very difficult to distinguish in electron microscopy tissue sections.


Control of respiratory therapy in flail chest.

Pulmonary mechanics and oxygenation were measured in 24 consecutive patients with posttraumatic flail chest requiring continuous mechanical ventilation. The mean duration of mechanical ventilation was fourteen days. Mortality was 38% for all patients, 29% if deaths from head injury are excluded. Pneumonia occurred in 4 patients (17%) and pneumothorax in 1 (4%). Vital capacity and maximal inspiratory force measurements were useful in assessing chest wall stabilization. Total lung compliance correlated negatively with fatal outcome from respiratory failure. The alveolar-arterial oxygen gradient was not useful in assessing chest wall stabilization.


Fever in acute myelogenous leukemia.

Implications and course of fever were evaluated during hospitalization of 24 patients with acute myelogenous leukemia. Forty-five febrile episodes were identified. Fever present at admission was usually associated with a diagnosable and treatable infection; fever shortly after induction was self-limited; and fever during granulocytopenia was more likely to be associated with bacteremia. Bacteremia and pneumonia were the most common types of infection. Only Gram-negative bacteria and Candida were identified as causes of infection during life, with Pseudomonas and Klebsiella the most frequently isolated pathogens. Invasive candidiasis was a major postmortem finding. A delay in initiation of empirical treatment beyond the third day of fever was associated with an increase in mortality as was continuation of treatment for longer than 14 days.


Myopathies related to diabetes mellitus and other metabolic diseases.

Although it has long been known that both large and small blood vessels are abnormal in the tissues of diabetic patients, recent work has emphasized the widening of capillary basement membranes in diabetic tissues. Current views of  the nature of this lesion and its relationship to diabetes are discussed and diabetic muscle and nerve lesions are emphasized. Other metabolic diseases with significant muscle pathology are types II, III and VII glycogen storage diseases. Myopathy with abnormal mitochondria is reviewed.


Leukemic urate nephropathy.

The tubules appear to be the primary sites of injury in renal failure and urate nephropathy associated with leukemia. Tubular injury is not always associated with precipitation and phagocytosis of crystals, except in the collecting tubules where cellular changes are invariably caused by intraluminal crystallization of urates. The electron microscopical observations in this communication may apply to the urate nephropathy associated with hyperuricemia of various causes.


Minimizing radiation exposure in dental radiology.

Rectangular field collimation gives high quality roentgenograms and reduces unnecessary exposure of radiation to the patient by 73-96 per cent.


A restraining device for irradiating rats.

The construction and use is described of a holding device which ensures replication of irradiation procedures for rats and the location of the animal for maximum ionization in the selected area.


Extraction socket healing in the calcium deficient rat.

The healing of extraction sockets was studied in normal and calcium deficient rats. New bone formation occurred earlier and proceeded more rapidly in the deficient rats, and the newly formed trabeculae were sparse and delicate but with a similar osteoporotic appearance to the alveolar bone.


A lapping apparatus for hard tissue sections.

A Lapping Apparatus is described which enables sections both embedded and unembedded to be ground plano parallel within +/- 1 micron. Sections cemented to steel subplates are retained by a magnetic holder which simplifies loading and unloading. Good surface and edge finish can be obtained and only short lapping times are required.


Excessive long-term dimensional change of dental amalgam.

Increase in dimension in relation to mercury content, annealing time at 37 degrees C at 24 and 3500 hours and mercury content of dental amalgam mixed by machine and hand-packed in cylindrical moulds is shown.


Oral hygiene home care kits: effects on the dental behaviour of kindergarten children.

Oral hygiene kits issued directly to children of kindergarten age positively influenced their dental care behaviour. Significantly increased percentages of children changed to using the clinically proven fluoride toothpaste, an approved type of toothbrush, and disclosing tablets, the three oral hygiene aids included in the kit.


South Australian kindergarten children: fluoride tablet supplements and dental caries.

A study of 4,278 country and city kindergarten children living in South Australia showed 63 and 59 per cent received fluoride tablets at some time and 17 per cent received daily doses. Lower dmf scores were found in those taking fluoride tablets but of decreasing value in the older children. Where no fluoride was taken zero dmf scores were 41-69 per cent. Protection from fluoride was not found where fluoride was taken for less than two years. Self administration appears to be an unsatisfactory method for fluoride therapy.


Anatomy of root canals. IV deciduous teeth.

The root canal systems of the deciduous teeth have been demonstrated by the epoxy resin injection technique. A major difference is noted between the simplicity of that seen in the incisors and the molars.


Oral surgery in general dental practice. The removal of roots.

The removal of fractured teeth and retained tooth roots is described in a systematic fashion, with emphasis being placed on such procedures being carried out in general practice. The discussion is aimed at producing sound treatment planning and sequential action in order to achieve best results for patient and surgeon.


Retention with specific and mechanical adhesive lutes.

Attention is drawn to some of the fundamental differences between retention afforded by specifically adhesive and mechanically adhesive lutes. Terms are defined and conclusions drawn regarding the present status and potential of polyacrylate cements.


Effect of manipulative variables on the properties of a polycarboxylate cement.

Strength and film thickness increased in polycarboxylate cement as the powder liquid ratio is increased and there is a tendency to reduction in adhesion which was more marked when cementation was delayed for three minutes with a 2:1 powder liquid ratio.


Innervation of the temporomandibular joint.

The human temporomandibular joint in transverse and longitudinal section was found to have two types of mechanoreceptors. One of capsular form approximately 40 times 200 mum innervated by myelinated nerve fibres 8 mum in diameter and the other corresponding to the Golgi tendon organ was innervated by myelinated nerve fibers 15 mum in diameter which on entering the tendon organ lost their myelin sheaths.


Silane coupling agents in stainless steel and polymethyl methacrylate systems.

Smooth stainless steel rods coated with silanes were embedded in acrylic resin dough. The strength of the bond between treated rods and polymerized resin was improved compared with that found in the untreated rods under all conditions of the tests. The strength increased with age when specimens were left in air; immersion in water lessened the increase in strength.


The treatment of first permanent molars in a school dental programme: implications for fissure sealants.

Analysis of data derived from the pattern of treatment for first permanent molars in New Zealand school children from fluoridated and non-fluoridated areas shows that occlusal surfaces became carious at a later age in the former and in such areas sealants could further reduce the need for occlusal restorations. Since occlusoproximal restorations are rare, retention of sealants for long periods is needed.


Oral surgery in general dental practice. The removal of malpositioned premolars and canines.

Malposed mandibular and maxillary premolars and canines often cause great difficulties in removal. The ways in which these procedures are accomplished are described in detail.


Epithelial-mesenchymal interaction in palatal shelf fusion. An in vitro study.

Cleft palate is the result of a number of deviations from normal facial development, including failure of the paired palatal shelves to fuse in the midline. By the use of in vitro techniques it is possible to isolate and study fusion alone. This study investigates some of the epithelial-mesenchymal interactions involved and finds that contact between two epithelial covered surfaces is essential for fusion.


Dental health on Mornington Island.

A group of remote island Australian Aborigines was examined for dental caries, periodontal disease, pathologic disorders and orthodontic problems and the results were recorded. It would appear that race and heredity may influence periodontal disease.


Six years of fluoridation on the goldfields of Western Australia.

The Kalgoorlie-Boulder-Kambalda area in arid inland Western Australia receives its water supply from distant Perth, through a pipeline constructed in the fabulous goldrush period at the turn of the century. This water was fluoridated at the source in 1968. Comparison of dental data obtained by examination of goldfields schoolchildren before and after 6 years of fluoridation shows improved dental health through reduced caries rates, less tooth loss, and a change in the pattern of child dental care.


Technique of surgery of the mandibular joint.

A method of surgical access to the temporomandibular joint is described. An operative technique which widely exposes the temporomandibular joint, safeguards the facial nerve, and is capable of extension is described. Sixty operations have been carried out without permanent facial nerve injury.


A comparison of methods for determining setting rate of amalgam.

Four methods were compared for determining the setting rate of amalgams. The resultant order of preference as a standard method was compressive strength at 30 minutes after preparation of the specimen, the time to the last transverse cut on a cylindrical specimen with a "guillotine" blade and the time to nonfracture of a ball of a amalgam with a final set Gillmore needle. A mercury absorption method was unacceptable. Alloys labelled fast and standard setting could be separated and limits between fast and standard alloys have been examined for each method.


Pericarditis in acute myocardial infarction.

In 1505 patients with acute myocardial infarction (MI) pericarditis was diagnosed most often in those with anterior transmural ECG changes. Those with pericarditis had a significantly greater hospital mortality and peak serum lactic dehydrogenase (LDH) levels and a greater incidence of left ventricular failure (LVF).


Acute coronary artery disease and oral contraceptives.

The Waikato Hospital experience of women admitted or seen in the Cardiology Outpatient Clinic who were under the age of 40 and whose diagnosis was a recent acute coronary occlusive episode was reviewed. It was found that there were nine admissions in eight women in this category between December 1971 and November 1973, plus one further patient who was seen with a recent acute ischaemic episode as an outpatient. The histories of these patients were reviewed and their risk factors surveyed. Of the nine women in the study, seven were taking oral contraceptives. As opposed to previous studies, not all the women in this study showed risk factors other than oral contraceptive usage. Three patients in this group taking oral contraceptives and who were thought to have definite coronary ischaemic episodes had no other major risk factor though two of the three were obese. It is thought probable that oral contraceptives containing oestrogens should be considered as a coronary risk factor in young women.


Effect of high dose spironolactone and chlorthalidone in essential hypertension: relation to plasma renin activity and plasma volume.

The effect on blood pressure of high (400 mg/day-S400) and moderate dose (200 mg/day-S200) spironolactone and chlorthalidone (100 mg/day-C100), given in a random double-blind manner was related to plasma renin activity and plasma volume in 38 essential hypertensives. The fall in pressure from a control of 154/103 mm Hg was essentially the same after four weeks of each drug--S400 deltaBP 24/13 mm, S200 18/9 mm, C100 17/12 mm (all P less than 0-001). Twelve of 37 patients (32%) had low initial renin, but this appeared as responsive to the chlorthalidone stimulus as that of the normal renin group. The antihypertensive effect of all regimens was unrelated to plasma renin activity. Plasma volume was significantly lowered at the end of each treatment period, but the decline could not be correlated with blood pressure effects. Patients with initially low plasma volume were more likely to respond to S400 (r = 0-545, P less than 0-001), whereas the antihypertensive effect of the S200 and C100 regimens was independent of this variable.


Interaction of bile with erythromycin Lactobionate in vitro.

An interaction of bile with erythromycin lactobionate in vitro has been demonstrated. The major bile components involved in this interaction have been shown to be the bile salts. The nature of the bile salt-erythromycin interaction has been investigated. The way in which an interaction between bile salts and erythromycin in vivo might lead to the hepatic dysfunction and cholestasis associated with some instances of erythromycin therapy is discussed.


Tachyarrhythmias in acute myocardial infarction.

In 1505 patients with acute myocardial infarction (MI) serious ventricular arrhythmias were commoner in those with transmural ECG changes, and were associated with an increase in mortality and in the incidence of left ventricular failure (LVF) as well as higher peak serum lactic dehydrogenase (LDH) levels. Atrial fibrillation (AF) occurred more often in older patients and in those with LVF and clinical evidence of pericarditis.


Observations on Maori-European lung function differences.

One hundred and twenty-one regular soldiers between the ages of 18 and 34 years, who had lived and worked under identical conditions for the two previous years were examined. All subjects with respiratory symptoms of wheeze, dyspnoea, persistent cough or sputum were excluded. Smoking, per se, was not a reason for exclusion. Eighty-three "respiratorily fit" men, comprising 47 Maoris and 36 Europeans, were studied to see whether height, weight or obesity could account for the ethnic differences in lung function. The forced vital capacity in the Maoris was found to be about 9% lower than in the Europeans. The one-second forced expiratory volume of the Maoris was about 8% lower than in the Europeans. No significant difference could be found in the peak expiratory flow rates between the two ethnic groups. The only significant physical difference found between the two ethnic groups was that the Maoris were heavier for their height than the Europeans. Statistical tests showed that neither weight nor an obesity index accounted for the ethnic differences in lung function. Full laboratory investigation of these ethnic differences is recommended.


The spectrum of liver diseases in alcoholism.

Liver biopsies obtained from 100 alcoholic patient attending a clinic primarily for the management of their alcoholism, have been reviewed. The morphological appearances have been correlated with histories of alcohol consumption and with clinical and biochemical findings. There were 77 men and 23 women. Eight biopsies appeared normal, 62 showed fatty liver with or without fribrosis, 17 had alcoholic hepatitis with or without fibrosis and 13 had alcoholic hepatitis with established cirrhosis. Patients with fatty liver had drunk as long and as heavily as those with alcoholic hepatitis, suggesting that some other factor in addition to alcohol is of importance in the development of alcoholic hepatitis. Clinical and biochemical abnormalities showed no constant relationship to histological findings. Thus liver biopsy would seem to be an essential part of the full clinical assessment of the alcoholic patient.


Constrictive pericarditis following mild non-penetrating trauma.

A case of constrictive pericarditis developed within twenty-four days of mild, blunt thoracic trauma. Rapid progression from traumatic pericarditis to constriction is documented with clinical evidence, electrocardiographic changes and cardiac catheterisation data. Other manifestations of pericardial reaction after blunt chest trauma are reviewed briefly.