Lanzkowsky, P., Shende, A., Aral, I., Saluja, G. (1975). Archives of Disease in Childhood, 50, 685. Organ irradiation and combination chemotherapy in treatment of acute lymphocytic leukaemia in children. A total of 30 consecutive children with acute lymphocytic leukaemia (ALL) were treated from June 1971 until December 1974. Remission was induced with the use of vincristine and prednisone. After induction of remission, cranial irradiation and intrathecal methotrexate were given. Then the liver, spleen, and kidney were irradiated and 6-mercaptopurine, cyclophosphamide, and methotrexate were administered during the maintenance phase. Pulsed doses of vincristine and prednisone were administered at 10- to 12-week intervals. The patients were subdivided into two groups based on their initial white blood cell (WBC) counts: a standard risk group with an initial WBC count of less than 25 000/mm3 (25 X 10(9)/1) and a high risk group with an initial WBC count greater than 25 000/mm3 (25 X 10(9)/1). Of the 30 children entered in this study one standard risk patient died in the induction phase before attaining remission. Analysis of the results is therefore based on the remaining 29 patients, 22 standard risk and 7 high risk patients, who attained complete remission. Survival rates in continuous remission were found to be 43% of the high risk group, 88% for the standard risk group, and 77% for the combined group. Analysis of the data indicates that this therapy is unsatisfactory in high risk ALL. The results to date of this therapy for standard risk are sufficiently encouraging to continue its use in this subgroup of patients.


Arterial embolectomy in the lower limbs.

A series of arterial embolectomies of the lower limb is reviewed, and the results are compared with those in a previous series reported from this hospital. There were 40 emboli in the 36 patients, with an operative mortality of 16% and a limb salvage rate of 85%. This represents a considerable improvement on the results reported from the first series and is attributed to the greater experience of surgeons with the Fogarty embolectomy catheter. However, there has been no decrease in the delay between the onset of symptoms and the embolectomy. If this aspect of management could be improved, then even better results should be obtained.


Upper limb emboli: a reappraisal.

Upper limb embolus cannot be regarded as a benign condition, with invariable recovery due to copious collateral circulation. Gangrene of the upper limb may occur, as shown in the series of cases in this report. The overall mortality rate remains considerable, because of associated cardiac disease, recurrent embolism, or both. Emboli proximal to the origin of the profunda brachii artery represent a group associated with higher risk, for which prompt embolectomy is often indicated. In embolism due to subclavian aneurysm and with thrombosis, arterial reconstruction should be undertaken, for multiple recurrence is likely. Long-term anticoagulant therapy is usually required to try to prevent recurrence of embolism if the primary source of the embolus remains.


A comparison of the supraclavicular and axillary approaches to upper thoracic sympathectomy.

Twenty-nine upper dorsal sympathectomies have been carried out in 18 patients and a comparison made of the supraclavicular with the axillary approach to the upper thoracic sympathetic chain. Thirteen of these operations were carried out for essential hyperhidrosis, 15 for ischaemia in the hand and one for post-traumatic pain syndrome. Fourteen sympathectomies were carried out through the axilla and 15 through the supraclavicular approach. Post-operative pain was felt to be somewhat more severe when the axillary approach was used, but other complications were infrequent and hospital stay was slightly shorter in the axillary group. The axillary approach was felt to offer superior exposure, the capability for wider sympathetic excision, good cosmetic results, avoidance of Horner's syndrome and low morbidity. In the absence of lung disease or the need for a direct exploration of the root of the neck, the axillary approach is to be preferred for upper dorsal sympathectomy.


Unilateral painful vasospasm in the lower limbs of young women.

The cases of five young women who presented with severe pain and associated vascular changes in one foot are described. The pain was spontaneous in onset and lasted for days, and its severity was such that none of the patients were able to walk without disability. Arteriography in three patients revealed arterial spasm. All had a good response from lumbar sympathectomy on the affected side.


Subvalvular left ventricular aneurysm following mitral valve replacement.

Two cases are presented which represent different aspects of damage to the posterior wall of the left ventricle following mitral valve replacement. In the first case rupture of the ventricle occurred in the immediate postoperative period with a fatal result, while in the second, delayed aneurysm formation occurred with embolic and haemodynamic complications. This patient also did not survive. A review of the literature reveals four similar cases previously recorded. Possible aetiological factors are considered, including operative trauma, ischaemic damage, rupture of unsupported muscle, previous surgery with the development of pericardial adhesions and fixing of the valve ring, and finally abscess formation. The indications for operative intervention and possible complications of the aneurysm are noted.


Diaphragmatic rupture with cardiac tamponade.

Intrapericardial herniation of abdominal viscera following blunt abdominal trauma is rare. We have been able to find only nine reported cases. Six of these were finally diagnosed after a long delay, ranging from a year to 23 years. Three were diagnosed within three months of the original injury, but in these patients, the investigations were initiated following an abnormal chest skiagram. We wish to report a unique case in which a traumatic intrapericardial hernia presented as an acute cardiac tamponade within 48 hours of injury.


Dolichocolon.

A plea is made for the recognition of a disorder of the colon, commonly encountered in the elderly, which is characterized by elongation (and also by dilatation) of the colon, especially the sigmoid. It may give rise to symptoms which suggest a diagnosis of carcinoma. The condition is believed to be acquired, and is an important aetiological factor in the development of sigmoid and, less frequently, of caecal volvulus.


Pancreatitis following intestinal bypass for obesity.

Three out of 24 patients undergoing intestinal bypass in the treatment of morbid obesity have developed acute pancreatitis in the postoperative period. All three had undergone end-to-end jejunoileal bypass. This serious postoperative complication has been infrequently recorded. Its significance and possible aetiological factors are discussed.


Carcinoma of the oesophagus: preoperative irradiation followed by planned resection for lesions in the middle and lower thirds--an interim report.

Since 1968, at the Thoracic Surgery Unit in the Royal Perth Hospital, a combined approach of preoperative deep X-ray therapy and excisional surgery has been adopted for patients with potentially operable carcinoma of the oesophagus. This has produced an improvement in the survival time for middle third lesions when compared with the result previously obtained following unaided surgical excision. The method is described, and the early results are indicated.


Gallstone erosion of the aorta.

A case of fatal erosion of the abdominal aorta by gallstones is reported. The patient presented with a six-day history of melaena and died suddenly 39 hours after admission to hospital, with massive blood loss per rectum. At post-mortem examination a saccular cavity containing gallstones was found at the lower end of the common bile duct. The cavity communicated in front with the duodenum and behind with the aorta. This case appears to be the first of its kind to be reported.


The in-vitro action of lymphocytes on autologous colon epithelial cells in ulcerative colitis.

The action in culture of peripheral blood lymphocytes on autologous large-intestinal epithelial cells was studied in 13 patients with severe mucosal ulcerative colitis. Two different methods were used to measure lymphocyte activity. These showed that autologous-lymphocyte-induced release of isotopic label and detachment in monolayer culture of large-intestinal epithelial cells was increased in acute ulcerative colitis when compared with findings in the same studies in six normal subjects. Subsequently in four of the six patients who responded to cortisone it was shown that lymphocyte activity against epithelial cells returned to the normal range. Further control studies showed little lymphocyte activity against autologous skin and ileum, suggesting that autologous-lymphocyte-induced damage of large-intestinal epithelial cells is a tissue-specific reaction in patients with acute ulcerative colitis. The absence of reactivity in other colonic inflammatory diseases also suggested that such increased in vitro lymphocyte activity is disease-specific for ulcerative colitis.


Anaesthesia for portocaval bypass in patients with metabolic diseases.

The biochemical lesions of the glycogen storage diseases and of familial hyperlipidaemia are discussed and the anaesthetic management of patients with these conditions, for the procedure of portocaval bypass, is described.


The anatomical and alveolar deadspaces during respirator treatment. Influence of respiratory frequency, minute volume and tracheal pressure.

In 10 patients receiving prolonged respirator treatment, respiratory deadspace was measured at 12, 18 and 24 b.p.m. and with two different minute volumes. The physiological deadspace (the sum of apparatus, anatomical and alveolar deadspaces) was derived using the Bohr equation, and the anatomical and alveolar deadspaces were measured by carbon dioxide analysis. Tracheal pressure was measured concurrently. The physiological deadspace to tidal volume ratio was increased on increasing the frequency, and was slightly reduced by an increase in minute volume. The mean values for anatomical deadspace ranged from 144 to 277 ml under the different conditions studied. Neither frequency nor minute volume had any influence on the VD/VT ratio. The volume of the alveolar deadspace was the less than half of the anatomical deadspace. The VD/VT ratio did not vary with frequency or minute volume. A relationship between tracheal end inspiratory pressure and anatomical deadspace was found, with a correlation coefficient of 0.80. The slope of the regression line indicated a high airway compliance of approximately 10 ml/cm H2O.


Blood leucocyte enzymes. II. Activities at 8-9 a.m. in cells of normal subjects, chronic lymphatic leukaemia and chronic myeloid leukaemia patients.

The activities of glucose-6-phosphate dehydrogenase (D-glucose-6-phosphate: NADP oxidoreductase, G6PD), 6-phosphogluconate dehydrogenase (6-phospho-D-gluconate: NADP oxidoreductase, 6PGD), hexokinase (ATP: D-hexose 6-phosphotransferase, Hx), lactate dehydrogenase (D-lactate: NAD oxidoreductase, LDH). glutamate oxaloacetate transaminase (L-aspartate: 2 oxoglutarate aminotransferase, GOT) and dihydrofolate reductase (DHFR) were measured at 8 a.m. in leucocytes of healthy individuals and patients with chronic myeloid leukaemia (CML), chronic lymphatic leukaemia (CLL), myelofibrosis with myeloid metaplasia and polycythaemia vera. In view of the heterogeneity of the leucocyte populations in these conditions, the enzyme activities were correlated to the number of immature cells in CML and to the percentage of lymphocytes in CLL. No differences in the enzyme activities were found between the white cells of healthy individuals, myelofibrosis with myeloid metaplasia and polycythaemia vera. In CML the activities of all enzymes except GOT correlated directly with the number of immature cells; an inverse correlation with the number of lymphocytes was observed in CLL. GOT was the only enzyme whose activity correlated with the number of lymphocytes in the cell suspension. Furthermore, a significantly higher activity of this enzyme was found in Ficoll-isolated CLL lymphocytes as compared to normal lymphocytes.


Leukaemia in children and their grandparents: studies of immune function in six families.

Seven of 500 children with acute leukaemia seen over a 15-year period were known to have a close relative with leukaemia or lymphoma. In each case the affected relative was a grandparent of the child, six of the seven being paternal grandparents. Investigation of thses six families showed that the fathers, who had two affected first-degree relatives, had lower lymphocyte counts and higher serum IgA concentrations than paired controls. Atopy, repeated infections and rheumatic disease were common amongst the parents and their sibs. The findings suggest a possible immunodeficiency basis for leukaemia in these families and perhaps also for acute lymphoblastic leukaemia of childhood in general. In the only family in which three generations, including both leukaemic patients, were available for HL-A typing, the affected grandson had not inherited either of his affected grandmother's haplotypes.


Karyotypic abnormalities in transformed chronic granylocytic leukaemia.

Chromosomal abnormalities in three cases of chronic granylocytic leukaemia are presented. The relative importance of 'specific' chromosomal abnormalities, additional to the Ph1 in the karyotypic evolution of chronic granylocytic leukaemia is discussed. A new abnormal metacentric chromosome is described.


Chronic myelomonocytic leukaemia.

The natural history and haematological features of 18 patients with a chronic form of myelomonocytic leukaemia are described. The majority were elderly and, in this series, females predominated. Haematological prodomata, such as unexplained monocytosis, leucopenia, or thrombocytopenia were common, and the clinical onset was insidious. Splenomegaly was variable but tended to increase as the disease progressed. Anaemia was usually less than in the acute disease, unless compounded by iron deficiency. The blood film typically showed a mixed monocytosis and granulocytosis, cells in both lines showing abnormalities. 'Paramyeloid' cells, appearing in Romanowsky stained films intermediate between myelocytes and monocytes, were characteristic, although cytochemical and electron microscopical analysis suggests that these cells may be allotted to one or other cell line. The marrow aspirate was characteristically hypercellular, showed granulocytic hyperplasia, and, in contrast to the well-differentiated blood picture, the proportion of poorly differentiated cells, including blasts, was high. Serum lysozyme levels were usually raised. Five of the 18 cases survived more than 5 years, while 10 lived 2 years or longer. The morphological and clinical features form part of a spectrum including acute myelomonocytic leukaemia, into which several of the patients transformed. Recognition of the syndrome is important because the patients are probably best managed without intensive chemotherapy.


Dyserythropoiesis and annulate lamellae.

Cytoplasmic and intranuclear annulate lamellae in the erythroblasts from patients with dyserythropoietic anaemia (megaloblastic anaemia, dysplastic anaemia and erythroleukaemia) are described. Annulate lamellae have mainly been observed in oocytes, in embryonic tissues and in malignant cells. Their occurrence in dyserythropoietic anaemia may be related to the reappearance of fetal characteristics in the erythroblasts and erythrocytes.


Hypoplastic acute myelogenous leukaemia.

The clinical course, diagnosis and management of nine cases of hypoplastic acute myelogenous leukaemia are described. Such cases may follow a slowly progressive course and should not receive anti-leukaemic chemotherapy unless the disease is advancing rapidly or unless some specific complication develops. If chemotherapy has to be given, usually because of severe and recurrent infections, then prompt and prolonged remission of disease may occur.


A comparative study of acute myeloblastic leukaemia in children and adults.

The presenting features and clinical course of 89 adults and 15 children with acute myeloblastic leukaemia (AML) presenting to a Regional Leukaemia Centre has been analysed. Remission rate was related to age, being 40% for the total adult group and 60% for all children. Young adults and children had a particularly high remission rate, whilst elderly patients faired badly. Survival diminished with increasing age and patients who entered complete remission survived for a significantly longer time (P less than 0.001) than those who did not. Adult AML differs from childhood AML, the adults having a lower remission rate, a significantly shorter survival (P less than 0.005) and almost complete absence of second remissions. Adults showed no correlation between complete remission and initial WBC or initial blast cell count, but in children there was a significant correlation (P less than 0.05) between initial total WBC and complete remission. A significant correlation between initial platelet count and complete remission could not be demonstrated in either group. Although the numbers of children are small, preadolescent children may represent a favourable sub-group, particularly those between 7 and 8 years of age.


Portal hypertension in chronic leukaemia.

Portal haemodynamic studies were carried out in 11 subjects, seven with chronic myeloid leukaemia and four with chronic lymphatic leukaemia, and results compared with those obtained in five patients with 'idiopathic' splenomegaly and with control subjects. All 11 patients with chronic leukaemia had intrasplenic pressures above 11 mmHg and of these four had pressures above 20 mmHg. Portosystemic collaterals were seen on splenovenography in four of these patients. Hepatic vein wedge pressure was above 7 mmHg in nine patients and these high levels were a result of increased free hepatic vein pressure. The corrected sinusoidal pressure and post sinusoidal resistance were essentially normal in all patients. Evidence of increased pre-sinusoidal resistance was seen in six patients. Estimated hepatic blood flow above 1500 ml/min was seen in six patients and all had evidence of histological portal or sinusoidal infilatration. Patients with 'idiopathic' splenomegaly regardless of increased liver blood flow did not have a significant increase in intrasplenic pressure and no alteration in other haemodynamic parameters. It appears that increased liver blood flow alone in a normal liver can only minimally elevate intrasplenic pressure but can play a significant part in the pathogenesis of portal hypertension when liver structure is altered.


The three transcobalamins in myeloproliferative disorders and acute leukaemia.

The unsaturated vitamin B12 binding capacity of whole serum (UBBC) and of the three transcobalamins (TC) has been studied in patients with various haematological diseases including myeloproliferative disorders (MPD) and acute leukaemia. The binding capacity of TC I and TC III was increased in MPD; TC I being particularly high in chronic granulocytic leukaemia (CGL) and TC III especially raised in polycythaemia rubra vera (PRV) and in infectious leucocytosis. The binding capacity of both TC I and TC III correlated with blood neutrophil count and the ratio TC III/TC I was low in CGL and increased in PRV. TC II was increased in acute myelogenous leukaemia, during remission and blast cell crisis of CGL and in refractory anaemia with excess of myeloblasts but not in acute lymphoblastic leukaemia (ALL). TC II correlated inversely with blood neutrophil count. There is an inverse ratio between TC II and TC I at least in myelogenous leukaemia. These abnormalities are discussed in relation to granulocyte kinetics. TC III and TC I reflect probably the total body granulocyte pool and share some biochemical and immunological properties supporting the view that they have a common origin in the more mature stages of the granulocyte cell line while TC II probably originates partly in more primitive granulocytes.


The cryosurgery of bone. An experimental and clinical assessment.

The histological response of bone to freezing is descirbed and it is suggested that there are three overlapping phases: osteogenic and remodelling. Different methods of freezing bone are evaluated using thermographic data and conclusions are made regarding the clinical application for each in the region of the jaws. The use of cryosurgery is described in the treatment of a group of patients with odontogenic keratocysts. It was used in an attempt to eliminate residual cellular rests and reduce the tendency to recurrence.


Cryosurgery, and its application to oral surgery.

The biological mechanisms of tissue necrosis by controlled freezing are discussed, with particular reference to their importance in cryosurgical technique. The clinical events following cryosurgery are decribed, together with common complications. As the oral mucosa is particularly amenable to this form of treatment, it has been used on a wide variety of oral lesions. From observations based on the treatment of over 300 patients, the advantages, disadvantages, relative indications and suitable variations in technique of cryosurgery are discussed.


The management of Ludwig's angina.

A severe case of Ludwig's Angina which was treated along the historical lines of surgical decompression is presented. The problem resulting from this approach are discussed together with alternative methods of management. The conclusion is made that surgical decompression as a means of avoiding respiratory obstruction should be abandoned and that tracheotomy should be used.


Cervico-facial and intra-oral actinomycosis: a 5-year retrospective study.

Actinomycosis is often considered to be a rare disease in the oral region. A retrospective study of the Routine Diagnostic Services in Glasgow Dental Hospital revealed 39 cases in which actinomyces were detected, indicating that this organism is not infrequent in oral infections and may be seen in a variety of lesions.


Temporomandibular arthrokinetic reflex control of the mandibular musculature.

The results of an experimental electromyographic investigation of temporomandibular arthrokinetic reflex control of the mandibular musculature are reported. Co-ordinated, rapidly adapting and slowly adapting facilitatory and inhibitory reflex changes in motor unit activity in the mandibular musculature were evoked by graduated passive movements of the isolated (but innervated) temporomandibular joint. Induced dysfunction of regionally discrete groups of articular mechanoreceptors was shown to result in specific changes in static and dynamic reflex motor unit activity. The possible clinical significance of these changes is discussed.


Physiological changes associated with unilateral pulmonary ventilation during operations on the lung.

No important changes in the respiratory parameters were observed during one-lung anaesthesia. However, this kind of thoracic intervention can be accompanied by a dramatic fall in arterial oxygen tension. Methods to avoid tissue hypoxia have been described. In our series no complications whatever occurred in the operative and post-operative periods which could be related to the oxygenation of the patient.


Comma-shaped venular segments of conjunctiva in chronic granulocytic leukemia.

Isolated comma or corkscrew-shaped venular segments in the conjunctiva have been felt to be diagnostic of sickle cell disease. External eye examination of a 34-year-old black man with a two-year history of chronic granulocytic leukemia revealed multiple small and medium-sized isolated conjunctival venular segments. Laboratory findings at the time of examination included a white blood cell count of 132,000/mm3 with 87% eosinophils, a hematocrit reading of 30%, and hemoglobin AA. Since whole blood hyperviscosity can be present in chronic granulocytic leukemia as well as sickle cell disease, this may account for the similarly of the conjunctival changes.


Female genital self-mutilation, dysorexia and the hysterical personality: the Caenis Syndrome.

A detailed case report of female genital self-mutilation associated with dysorexia and the hysterical personality is presented. This lends support to recent literature that has suggested the possibility that these clinical features may comprise a discrete syndrome. The usefulness of considering this triad as a syndrome is illustrated by its facilitating the recall of two previous patients who in retrospect appear to fulfil these criteria. It is suggested that the name Caenis syndrome be given to this triad of behaviour.


Treatment of acute myeloid leukemia of childhood with cytosine arabinoside, daunorubicin, prednisolone, and mercaptopurine or thioguanine.

Eighteen children with acute myeloid leukemia have been treated with a four-drug protocol using cytosine arabinoside, daunorubicin, prednisolone, and mercaptopurine or thioguanine. The initial remission rate overall was 78%. Of 15 children who completed a week's treatment, i.e. one complete cycle, 14 entered complete remission (93%). The median survival was 7 months, and the median survival for those entering remission was 12 1/2 months.


Comparative study of cytosine arabinoside therapy alone and combined with thioguanine, mercaptopurine, or daunorubicin in acute myelocytic leukemia.

Three hundred twenty-six patients with acute myelocytic leukemia were randomly and prospectively assigned to four therapeutic regimens: cytosine arabinoside either alone or in combination with daunorubicin, 6-mercaptopurine, or 6-thioguanine. The results in 231 qualified previously untreated patients were analyzed. The combination treatments produced a significantly greater frequency of complete or partial remission than single drug therapy. Treatment with cytosine arabinoside and thioguanine led to 48% age-adjusted complete and partial responses. The median sur survival from diagnosis of all 66 evaluable patients treated with these two drugs was 18 weeks, while the median survival for those who responded to this combination was 15 months.


Cyclophosphamide-induced hemorrhagic cystitis in children with leukemia.

The records of 314 children with acute lymphocytic leukemia (ALL) were reviewed to determine the frequency, clinical and laboratory features; contributing factors; and prognosis of cyclophosphamide-induced hemorrhagic cystitis. Twenty-five well-documented cases of hemorrhagic cystitis were identified. While most of the affected children suffered a mild transient illness, 1 patient died as a result of bladder hemorrhage. The doses of cyclophosphamide received by these children ranged widely and did not correlate with the severity of the cystitis. The frequency of this complication did not differ significantly with sex, age or route of administration. However, cystitis was over twice as frequent in black children as in white. Nineteen of 25 cases occurred in the spring and summer months. The group of affected children did not differ significantly from a matched control group in terms of total drug dosage received, incidence of systemic toxicity, mean urine specific gravity, or overall survival.


Adjuvant chemotherapy in primary treatment of osteogenic sarcoma. A Southwest Oncology Group study.

A four-drug adjuvant chemotherapy regimen (CONPADRI-I) was utilized in the primary treatment of 18 children with osteogenic sarcoma. All patients had surgical amputation for the primary lesion. The children then received cyclophosphamide, vincristine, melphalan, and adriamycin in defined combinations intermittently over a 72-week period. Of the 18 patients, 10 (55%) remain free of disease 24 months or longer from time of amputation.


Thorotrast-induced extraskeletal osteosarcoma of the cervical region. Report of a case.

This is the seventh reported case of soft tissue sarcoma attributed to thorotrast extravasated during the course of an injection for arteriography. An extraskeletal osteosarcoma occurring the cervical region of a 51-year-old man 30 years after a cerebral arteriogram is presented. The other reported cases include a fibrosarcoma, two neurofibrosarcomas, two spindle cell sarcomas, and an extraskeletal chondrosarcoma. The latency period has varied from 5 to 30 years. The thorotrast granules are readily identified in macrophages near or adjacent to the tumor, and the demonstration of alpha tracks on autoradiographs is diagnostic.


Origins of nutritional imbalance in cancer.

Some parallels and differences are considered between the nutritional circumstances that favor carcinogenesis and those that favor tumor growth and host cachexia. From evidence on deletion of physiological feeding controls and changes in feeding behavior during tumor growth and from evidence on differences in sets of available feeding controls and in feeding behavior among normal individuals, it is suggested that acquisition of possibly carcinogenic dietary habits may originate, in part, from innate deficits in physiological feeding controls.


Survival of mice with metastatic osteosarcoma treated by cyclophosphamide or radiotherapy.

Dunn osteosarcoma cells injected i.v. into tumor-free isogeneic C3H/He mice resulted in artificial pulmonary metastases, which were treated by cyclophosphamide (100 mg/kg/day i.p. for 3 days) or single thoracic X-ray doses of 1500 rads either 1 or 14 days after tumor cell injection. Compared to untreated controls, reduction in lung colony number and increase in life-span for the 1-day metastases were 56 and 46% for radiated mice, and 100 and greater than 367% for cyclophosphamide-treated mice. Corresponding values for 14-day metastases were 42, 26, 85, and 98%, respectively. Nine of 44 mice bearing 1-day metastases treated by cyclophosphamide are surviving greater than 340 days after treatment. Both treatments resulted in the extension of life-span and reduction of the number of lung colonies, and, in both modalities, there was a reduced antitumor effectiveness when treatment was withheld until the disease was more advanced.


Application of engineering principles in management of spinal cord injured patients.

Engineering services currently being used for spine stabilization, respiratory assist, and pressure sore prevention are discussed as well as devices under development for bowel and bladder control, reduction of contractural deformities and spasticity, and electrical stimulation of paralyzed muscles. Concepts and devices for improved function are divided into categories of: orthotic devices; environmental control systems; mobility systems; page-turning devices. A wide range of engineering devices are available but strict attention must be given to medical rationale for their use.


Hormone suppression of DNA synthesis in cultured chondrocyte and osteosarcoma cell line.

Recent evidence suggests that endocrine factors play an important role in the natural history of osteosarcoma. The occurrence of this tumor in the metaphysis of rapidly growing adolescents, coupled with increased female survival led to the investigation of the effects of various hormones on cultured osteosarcoma cells. The in vitro effects of physiologic concentrations of human growth hormone, 17beta estradiol, and progesterone on cultured osteosarcoma cells and chondrocytes are presented. Growth hormone significantly enhances 3H-thymidine incorporation in osteosarcoma cells and chondrocytes, in the presence of human serum. The use of other sera, culture media, or heat inactivation of the human serum abolishes this effect. Estradiol and progesterone, alone, or in combination produce significant suppression of DNA synthesis in cultured tumor cells. Several sera contain a heat-labile factor which has the capacity to block the suppressive effect of estradiol. This factor could be overcome by increasing the concentration of hormone, or by heat-inactivation of the serum. The use of hormone therapy in the treatment of osteosarcoma has never been reported, despite its demonstrated value in certain other malignancies. In light of these observations and considering the poor prognosis in this disease it seems reasonable to initiate a study of adjunctive hormone therapy in osteosarcama.


Chondroblastoma of bone.

Chondroblastoma is a rare benign neoplasm of cartilaginous origin. It appears as a round or oval translucent area with a thin sclerotic rim situated most often in the epiphysis of a long bone, and occurs mainly in the 12-20 age group. It has an excellent prognosis and the radiological features should suggest the correct diagnosis. Ten cases have been reviewed in this paper. The clinical, pathological as well as the radiological features and the differential diagnosis of this entity are discussed. It is hoped that this will help in its earlier diagnosis.


Oral hygiene instruction and motivation in children using manual and electric toothbrushes.

The effect of individual chairside instruction and motivation on children using either manual or electric toothbrushes was investigated. From 123 children aged 9-15 years attending the Children's Department, Eastman Dental Hospital, four groups were constructed. Group 1 acted as the control, Groups 2 and 3 used manual toothbrushes and received instruction and motivation, and Group 4 used electric toothbrushes (Touch Tronic, Teledyne Aqua Tec) and also received instruction and motivation. For all children, modified Löe and Silness' Gingival and Plaque Indices were scored, a disclosing agent applied and a prophylaxis completed. Children in Groups 2, 3 and 4 were additionally shown the disclosed plaque, and its importance was discussed. Their attempts to "get the stain off" were checked and their own brushing techniques modified. Re-examinations took place after 1 and 3 months. To estimate the reliability of the diagnosis, 172 of the 344 examinations were repeated by a second operator. The overall coefficient of correlation (between operators) was 0.8. In the control group no detectable improvement in the gingival health or oral cleanliness occurred over the 3-month study period. However, both gingival and plaque scores decreased significantly, by 35-50%, in all instructed and motivated groups within 1 month and this improvement was still observable 2 months later. There were no significant differences in improvement between motivated children using manual or electric toothbrushes.


An epidemiologic study of osteogenic sarcoma in Malaysia. Incidence in urban as compared with rural environments and in each of three separate racial groups, 1969-1972.

To explore the possibility that environmental and/or genetic factors may yield clues to the etiology of osteogenic sarcoma, an epidemiologic retrospective study of all cases of osteogenic sarcoma in a country with clear geographic and racial variables (Malaysia) was conducted covering a 4-year period. Sixty-eight cases were identified (+85% of the predicted total). The incidence (cases per 100,000 population per year) was 0.11 in Malay, 0.23 in the Chinese, and 0.23 in the Indian. The urban versus rural incidence in the Malay was 0.22 versus 0.09, and in the Chinese 0.31 versus 0.18. The Indian population was too small when dividied into urban and rural segments to be significant.


Establishment and alkaline phosphatase activity of clonal cell lines of murine osteosarcomas. A preliminary study.

Clonal cell lines of murine osteosarcomas were established and have been maintained in vitro for over a year. By implanting these cultured cells into mice, osteosarcomas, whose histological picutres were exactly the same as those of the original tumors, were easily reproduced. The cultured cells of murine osteosarcomas contain an extremely high level of alkaline phosphatase activity. The cells also secrete a great amount of extracellular alkaline phosphatase in culture media.


Caries preventive effect of a fluoride-containing varnish (Duraphat) after 1 year's study.

The caries prophylactic effect of semi-annual applications of a fluoride-containing varnish (Duraphat) was tested in 121 15-year-old children. The children were divided into a test (60 subjects). The teeth of the children in the test group were coated with fluoride varnish at the beginning of the experimental period and again 6 months later. A clinical and radiographic examination of all children was performed immediately prior to the first application of varnish and 1 year later. The mean caries increment was 0.9 new DMFS in the test group and 4.0 in the control group. The difference was statistically significant at the 0.1% level. The caries prophylactic effect on different tooth surfaces was statistically significant both on proximal and on occlusal surfaces at the 0.1% level. Analyzing the material with respect to the caries prophylactic effect against the background of caries prevalence at the start of the investigation showed a better effect in the group of children with low and medium initial DMFS values.


Errors in diagnosis of approximal caries on bitewing radiographs.

The number of overlapped and unreadable surfaces occurring on bitewing radiographs of 1,417 children participating in a clinical trial was recorded. Of erupted surfaces, only 73.3% were completely visible to both participating examiners. Interexaminer and intraexaminer reproducibility ratios were calculated according to the F.D.I. recommendations. The ratios obtained in the present study ranged from 0.06 to 0.36. Almost 57% of approximal cavities were diagnosed on radiographic examination only: 21% were diagnosed clinically, but were not apparent on the radiographs.


Tooth loss in South Australia.

A survey of approximately 8,300 subjects in the State of South Australia indicated that approximately 228,400 South Australians aged 15 years and over (26%) were edentulous and, of these, 95% wore full maxillary and mandibular dentures. The proportion of edentulous subjects increased with age and was lower in males, upper socioeconomic groups, immigrants and in the State capital.


[Results of combined chemotherapy in treatment-resistant leukaemia of adults (author's transl)].

In 21 patients with acute leukaemia not or no longer responsive to conventional chemotherapy, and in four patients with chronic myeloid leukaemia in the blast phase, intensive combination treatment was started with thioguanine, daunomycine, cytarabine, methotrexate, prednisone, cyclophosphamide, and vincristine. Six patients with acute leukaemia went into complete remission, three into partial remission. The mean duration of remission was relatively short at 11 weeks. Of the four patients in the blast phase of chronic myeloid leukaemia two had objective and subjective remission. The toxicity of the combined treatment was not marked and subjective tolerance good. Such combined treatment is a realistic means of managing treatment-resistant acute leukaemia and chronic myeloid leukaemia in the blast phase.


[Co-existence of chronic myeloid leukaemia and carcinoma of the breast (author's transl)].

Chronic myeloid leukaemia and carcinoma of the breast co-existed in three women. This combination is exceedingly rare. Although the cancerogenic properties of ionizing radiation and cytostatic drugs could be held responsible for the occurrence of two malignant tumours, no definitive conclusions can be drawn in the individual case. Co-existence of leukaemia and carcinoma does not occur more frequently than could be predicted statistically from the incidence of each.


[Fluoride content of teeth following treatment with Zircate paste].

We extracted the four lower incisive teeth 41, 42 and 31, 32 of ten patients in age of 50-73 years. The indication was a profound marginal parodontopathy. Before extraction the incisors of the right side were treated with 9% stannous-fluoride. Five minutes after treatment they and the unfluoridated left incisive teeth 31, 32 were extracted. For transformation of 19F to radioactive 20F the extracted teeth were exposed to neutrons in the nuclear reactor. The incorporated radioactivity was proportional to the fluoride-concentration. Considering fluoridated (128,45 +/- 13,659 mug/g) and unfluoridated (128,6 +/- 14,88 mug/g) teeth, the fluoride concentration did not differ significantly.


[Tetracyclin and caries].

The influence of tetracyclines embedded in hard substances on caries predisposition of the teeth is tested in Syrian hamsters. Caries predisposition in the teeth that mineralized under tetracycline influence is by 67% smaller than in the teeth of the animals of the control group. This phenomenon can neither be explained by a permanent change in the microflora of the oral cavity nor by a local effect of the antibiotic resulting from dissolving processes when it is released. The reduction in caries predisposition can only be due to a change in the mineral structure of the enamel that developed under the influence of tetracycline.


[Lead and arsenic resorption in the hard tissues (crystallochemical studies)].

Histologic-analytical observations on the resorption of lead and arsenic compounds are put into relationship with crystal-chemical analogies in the composition of hard tissue and the structure of calcium phosphate apatites with lead and arsenic substitution. Chemical analyses and x-ray diffraction of calcium and lead apatites with phosphate and arsenate represented as mixed precipitates in solution equilibrium show that - with the exception of calcium arsenate apatite - linear diadochocinetic substitution conditions are existing. The composition of calcium arsenate apatite is clearly shown to contain much less arsenic. This result is explained by the crystallographic laws of substitution in the crystal lattice (diadochocinetic laws). The clinical and physiological findings in lead and arsenic resorption are confirmed by the found distributional equilibria.


[Report on the learning effect in school children following toothbrushing instruction by students].

After they had gone through a training program on the prevention of caries and periodontal disease, 20 students instructed young patients in how to brush their teeth. One of the students instructed a class of 35 pupils. The change-over from the learning situation to the situation at the patient was successful with 77% of the students. Questionnaires filled out by the patients before and after the instruction reveal that specific information and motivation regarding improved personal oral hygiene had increased.


[Reproducible and congruent radiographs for the study of bone structure].

Radiograms that are reproducible and are as identical as possible are an absolute prerequisite for objective early diagnosis of the smallest changes in the bone structure. Changes that are no longer visible to the naked eye, are recorded by photometry and can be represented objectively by computerized evaluation. It is the object of this study to develop a method for taking roentgenograms with films generally used in the dental office, which allows to always the area always to be radiographed reproducibly. The x-ray machine is described and tested on four patients. The radiograms are photometrically scanned and entered into a computer in order to check the location of the radiograph. The results show that with our method it is possible to take identical radiograms at different times.


[Jaw and dental abnormalities in children with cerebral movement disorders].

The dentitions of 146 children with cerebral palsy showed a high incidence of gnathic anomalies. There was, however, no relation between these anomalies and the severity of the neuropathological findings. Also the total number of anomalies was almost evenly distributed among the various clinical pictures such as spasticity, athetosis, ataxia. Although combinations of the individual anomalies were found most frequently, marked protrusions of the upper jaw were particularly impressive with 55%, and were followed by class II malformations (47%). In addition, almost every third tested child had an open bite.


["Dental worms" iatroanthropological report from northern Thailand].

It is reported on a therapeutical method of smoking dental worms out of carious lesions that was observed in Chaingmai, Thailand. Historical concepts regarding the development of caries and methods for removing dental worms compared with the observations described reveal identical ideas and methods.


[Articulation theory--today].

The classic theory of articulation (Hanau's quintet and Thielemann's formula) was to be modified on the basis of more exact methods of registering the mandibular movements. In the course of protrusion, laterotrusion and mediotrusion, different factors determine direction and inclination of the individual functional dental facets. The laws of articulation are redefined with regard to laterotrusion.


[Damage of the permanent teeth after icterus neonatorum gravis--a case history].

A case is reported in which, after icterus gravis neonatorum (I.G.N.) with subsequent exchange transfusion, highly discolored permanent teeth were observed with the six-year molars showing hypoplastic cusps. Possible connections between I.G.N and the discoloration and hypoplasia of the permanent teeth are discussed.


[The awareness of oral hygiene in Swedish and German school children].

Within the framework of an epidemiological survey of the dental and periodontal conditions in Swedish and German school children born in 1965, the children were asked to answer ten questions regarding oral hygiene in a questionnaire. When comparing the ten answers regarding the consciousness of oral hygiene, significant differences in knowledge were observed with the exception of information given with respect to their own toothbrush. This difference may be interpreted to the effect that the Swedish children are better aware of the importance of oral hygiene than the German children.


[The development of strength in the masticatory muscles and its sensory control].

By means of inductive dynamometers the absolute force of mastication as well as factors influencing that force are studied. In addition to the mechanical effects resulting from the lower jaw's acting as lever arm, the pulp, especially its coronal portion, showed a dominating influence on the extent of the developed adduction force.


[Report of case of opalescent dentin. A polariation optic and microradiographic study on a pulpless tooth].

Ground sections prepared from a molar (-7) with opalescent dentine were investigated by the means of polarizing microscopy and microradiography. Histological and clinical findings are discussed. Unfortunately, heredity could not be surely determined. But in all experience we are shure, that a hereditary mutation, recently or earlier in a generation occured, was the cause also in this case.


[Tongue pathology and its effect on the stomatognathous system in juvenile cerebral movement disorders].

Studies in 146 children with cerebral palsy revealed a definite relation between malfunctioning, size, and location of the lingual muscle and the development of the dentition. The results may be regarded as a confirmation of the so-called functional adaptation theory first observed by ROUX in 1921. The formative influence of the maxillo-facial musculature-including the musculature of the tongue-on the development of the dentition is determined by the proper interaction of the various groups of muscles. Oral muscular malfunctioning, as is often observed in children with cerebral palsy, therefore has a direct influence on the malformation of the jaws and the dentition.


Certain patterns of karyotype evolution in chronic myelogeneous leukaemia. Chromosome abnormalities in CML.

The study of chromosome banding pattern of leukaemic cells in 15 patients with CML revealed t(9;22) in all cases. Similar additional chromosome abnormalities were observed in the terminal stage of the disease in 5 of 9 patients with aneuploid cell lines. The most frequent abnormalities were i(17q) and trisomy 8. The regularities of karyotype evolution in the terminal stage of CML are discussed.


Radiographic manifestations of malignant mixed uterine tumors.

Malignant mixed uterine tumors have a varied radiographic appearance. The primary tumor is usually evident as an enlarged uterus, frequently with localized, faint, punctate calcification. New or increasing calcification within an enlarging uterus of a postmenopausal female should raise the suspicion of mixed malignant uterine tumor. Metastases are common, and usually involve the lung, most often becoming apparent quite rapidly. The pattern of pulmonary metastases is varied from large masses to lymphangitic spread, hilar lymph nodes and pleural effusions being common. Calcification within pulmonary secondaries may occur and cavitation has been observed.


Effect of a quinine-adulterated diet upon body weight maintenance in male rats with ventromedial hypothalamic lesions.

Male rats offered a quinine-adulterated diet after receiving either ventromedial hypothalamic or sham lesions displayed nearly identical periods of anorexia before maintaining their body weight at a stable but reduced level. When starved prior to surgery to a body weight below this reduced maintenance level, both ventromedial hypothalamic and control animals displayed an intial period of rapid weight gain on the quinine-adulterated diet. When subsequently offered only this diet for an 8-wk period, both groups, after castration, maintained the same reduced level of body weight. Thus, ventromedial hypothalamic animals overeat and become obese on palatable diets, but defend the same lower weight level as controls when challenged with unpalatable diets. Impairment of a mechanism setting the upper, but not the lower, weight limits is responsible for the greatly expanded range of body weights generated in the ventromedial hypothalamic animal by manipulation of diet palatability.


The increase in dental disease in the northern states of Nigeria and its manpower implications.

An epidemiological survey of dental decay was carried out in the six northern states of Nigeria on a population sample of 1396. The average number of decayed, missing and filled (DMF) teeth per person for the whole sample was 2-7. The percentage of caries-free persons was 47-1. Dental decay was more severe and widespread in the cities, where the mean DMF value was 2-8 and 42 per cent were caries-free, than in the villages, where the mean DMF value was 2-0 and 66-9 per cent were caries-free. The mean DMF index for the age group 10-19 years (which formed nearly 60 per cent of the sample) was 3-1, and untreated dental decay alone almost entirely accounted for this figure. This amount of untreated dental disease is an indication of the lack of dental treatment available as a consequence of the shortage of dental manpower, since only 15 dentists are available for a population of 28 800 000 in this area. Examination of the dietary habits of the population studied showed a remarkable level of consumption of sweets and sweet foods both in villages and cities. Overall, no fewer than 87 per cent of the people admitted to taking these cariogenic foods as snacks between meals. These habits are sufficient to explain the alarmingly increased incidence of dental decay and the decline in the number of caries-free persons when compared with earlier studies. This is an unhappy augury for the future dental health of Nigeria. The evidence of deterioration of dental health makes a national programme of dental health education and preventive dental treatment a matter of urgency. This necessitates a considerable increase in dental manpower if the population is to receive the maximum benefit.


Transverse bend testing of denture base polymers.

A test rig has been designed for transverse bend testing on the Instron machine. The rig is a robust, accurately machined piece of equipment that enables this test to be carried out with accuracy and ease. A range of denture base polymers has been tested under similar conditions to the ISO standard recommendations (ISO/R 1567, 1974), and in this series all the materials except 3 satisfied the criteria laid down in the standard. The specimens were tested in water after 1 month because it has been shown previously that the materials are almost fully saturated at that time (Stafford and Huggett, 1973). Nevertheless, this immersion in water may also weaken the material and this could account for the failure of some materials to pass the standards criteria.


Studies of mandibular movements in speech.

A method of transducing mandibular movements in speech using synchro-transmitters is described. Incisal occlusion was shown to have an important part to play in the amount and direction of jaw movement. Mandibular positions were shown to be precise and repeatable, especially for the 's' sound. Insertion of intra-oral appliances of varying dimensions did not have a significant effect on this positional precision. It is anticipated that the precision of vertical dimension determination during full denture construction will not be influenced by the dimensions of the intra-oral appliances.


Telemetry and the study of vertical jaw relations.

A method of monitoring vertical jaw separation over extended periods by radiotelemetry is given. The patterns of mandibular movement evoked by different activities such as rest, work, sleep and swallowing and the effect of a bite-raising splint are described. The influence of gravity and friction on mandibular rest position is discussed. The results were consistent with the view that the rest position of the mandible is determined by passive soft tissue balance, but subject to overriding muscular control as shown when a bite-raising splint was worn.


A note on the variation in the timing of deciduous tooth eruption.

A survey was carried out on the timing of deciduous tooth eruption based upon 3600 Caucasian children in three heterogeneous samples from Birmingham, Sheffield and Gloucester and a small more or less homogeneous sample from Biddulph (North Staffordshire). These data were compared with the eruption times derived from a sample of 600 British Negro children. Generally, the deciduous teeth of Negroes erupted before those of Caucasians, although the actual eruption times in each sample exhibited a greater degree of variability than is appreciated by most dental workers.


The reaction of rabbit tissues to implanted vitreous carbon.

Vitreous carbon, an allotropic form of carbon, may have a potential for the construction of implants. This paper describes experiments which have been conducted to assess tissue reactions to the material when it is inserted into bone. Implants were prepared with mean surface roughness values of 2-1 and 2-9 mum, and placed in the mandible and iliac crest of the pelvic bone of rabbits. The animals were killed after periods of up to 1 year, and the implant and surrounding tissues dissected out. The specimens were embedded in a resin and prepared for examination by light microscopy. Observations have been made on the tissue reactions in the two implantation sites, the effect of the surface textures and the significance of implant movement. The material excited very little tissue reaction and did not appear to be degraded.


Polynomial and catenary curve fits to human dental arches.

Polynomial and catenary equations were fit by least square error methods to the dentitions of seven children with "normal" occlusion. Mean and mean square error were then used to analyze accuracy of curve fits and asymmetries of arches. A lack of congruency for the "lines of occlusion" common to the maxilla and mandible suggest that the defining anatomic landmarks are inaccurate. These analyses show that the coefficients of the sixth degree polynomial equations appear to have potential as clinical indicators of arch form and, perhaps, malocclusion.


Initiation of cracks in dental amalgam.

The force required to initiate cracks in dental amalgam beams was measured and related to the microstructure. The force measured was dependent on age and on the distribution of phases on the tension side of the beam. The Ag-Cu phase is most resistant to failure in Dispersalloy and an experimental alloy.


Continuous in vitro measurement of mouse salivary gland enzymes.

A perifusion chamber technique is described that permits continuous measurement of the in vitro release of salivary enzymes from slices of mouse salivary glands responding to various stimuli. Kinetics of amylase secretion differed from those of esterase, which suggests that the secretory processes differ for these two enzymes.


Biosynthesis of collagen in isolated periodontal ligament.

This study showed that the excised periodontal ligament from humans and hamsters actively synthesizes protein, as measured by 14C-proline incorporation, when incubated in vitro for periods of 30 minutes to six hours. However, only a small percentage of the protein synthesized was collagen.


Short-term stress-relaxation behavior of nonmetallic restoratives.

The rheological behavior of five nonmetallic dental materials was studied. Short-term stress relaxation was found to be strongly dependent on time and temperature. Relaxation behavior of the test materials conformed well to simple mathematical models.


Lip and tongue pressures related to dental arch and oral cavity size in Australian aborigines.

Although the oral cavity and dental arches of the Australian aborigine are large, studies of lingual and labial pressures indicate that the tongue is neither unusually large nor strong. The Australian aborigine's pharyngeal cavity is smaller in height and depth than that of the American; just the opposite is true for the oral cavity. To the extent that environmental factors are important at all, the resting pressure of the lips, not tongue pressure during swallowing, is probably the significant determinant of dental arch dimensions.


Gelation of polyacrylic acid aqueous solutions and the measurement of viscosity.

A simple method is described for following changes in viscosity of concentrated aqueous solutions of polycarboxylic acids used in certain dental cements. The difference in behavior over several months between solutions of polyacrylic acid and related polyelectrolytes is discussed.


Lingual ascorbic acid test: poor correlation with blood and tissue levels of ascorbic acid in guinea pigs.

The lingual ascorbic acid test, based on the reduction and decolorization of the blue dye, 2,6-dichloroindophenol sodium, was evaluated in a group of guinea pigs conditioned to have a wide range of ascorbic acid levels in the tissues. The test did not correlate well with ascorbic acid levels in either blood or tissue.


In vitro wear response of composite resin, amalgam, and enamel.

A two-body, wear-testing method was developed and the test results were used for comparing and ranking the rate of wear for an amalgam, an experimental composite resin, and a commercial composite resin. The ranking of wear found by this method was the same as that shown by clinical research for the rate of wear of amalgam and commercial composite resin.


Feulgen microspectrophotometry of oral cancer and leukoplakia.

Feulgen microspectrophotometry was performed using the two wavelength method on 33 lesions and showed that five of ten carcinomas and 12 of 16 leukoplakias had diploid cell lines. This correlates well with similar findings in cervical cancer and dysplasia suggesting that changes in nuclear deoxyribonucleic acid content occur quite early in the evolution of cancer.


Effects of anti-inflammatory steroids on mouse embryonic movements during palatal development.

The frequency of spontaneous embryonic muscular movements was recorded for embryos from mice treated with cortisone or triamcinolone. Movement was significantly reduced in A/J strain mouse embryos exposed to these anti-inflammatory agents. Cleft palates induced by the drugs may originate from failure of the embryonic tongue to be withdrawn from between the palatine shelves.


Compressive viscoelastic properties of human dentin: I. Stress-relaxation behavior.

Stress-relaxation measurements were performed on specimens of radicular human dentin. The relaxation modulus showed a linear dependence on the logarithm of time and the approximation to the logarithmic distribution function of relaxation times was used to predict the behavior of other viscoelastic properties. This experimental technique provides significant criteria for the design of polymeric restorative and prosthetic materials.


Fluoride in dog parotid saliva after intravenous administration of sodium fluoride, sodium monofluorophosphate, and calcium fluoride.

Sodium fluoride, sodium monofluorophosphate, or calcium fluoride, in amounts equivalent to 0.5 mg/kg, were given intravenously to dogs and the effect on parotid saliva F was determined. Significant (P less than 0.01) differences in saliva F levels were related to the ionization of NaF, the hydrolysis of the PO3F ion, and the insolubility of CaF2.


Dynamic mechanical properties of maxillofacial materials.

Six maxillofacial materials were evaluated by determining their dynamic properties with use of a Goodyear Vibrotester. The dynamic modulus, internal friction, and dynamic resilience were measured for all materials over a temperature range of -15 to 37 C. The dynamic modulus ranged from 11.1 to 124.8 kg/cm2 and the dynamic resilience varied from 1.1 to 63.5%.


Continuing education: attitudes, interests, and experiences of practicing dentists.

This study was designed to examine the determinants of interest in formal continuing education courses of two different types, clinical and practice oriented. Major findings were (1) practice-oriented and clinically oriented courses differed in attractiveness among different segments of the dental profession, (2) interest in courses of a clinical nature was higher and more widespread throughout the proffession than was interest in management courses, and (3) half of the dentists supported mandatory continuing education for renewal of licenses, but 56% opposed a requirement that examinations in those courses be successfully completed. Interest in practice-related courses was related to age, income, use of allied health personnel, journal reading, and participation in study clubs. Clinically related courses were slightly more attractive to the sample than were practice-oriented courses, but current offerings of this type are less attractive to specialists than to general practitioners. Clinical courses generally appeal to the more active segments of the profession, and interest is associated with journal reading, participation in study clubs, and attendance at dental meetings. The appeal of clinical titles was more universal than that of management titles. Few background and practice characteristics were correlated with desire to keep up with the field, and those correlations that existed were smaller than those relating these variables to interest in practice; the only exception was specialization, as was noted above. Support for mandatory continuing education without examination as a requirement for relicensure was substantial. Further, no significant cleavages on this issue could be associated with any of the background or practice characteristics which were studied, a finding that indicate the existence of broad-based consensus in the sample.


Comparison of the effects of two handpiece locations on dental team performance.

Using audiovisual tapes of 150 actual dental treatment sessions, five dental teams working with handpieces positioned in the 8-o'clock location were compared with five dental teams working with hand pieces positioned in the 12-o'clock location. Criteria used for analysis were frequency and duration of instrument transfer, critical incidents that interfered with instrument movements, and subjective responses of the dental team members. The data showed that the handpiece transfers were faster and more frequent in the 12-o'clock location where they were done via the assistant. However, the reverse was true for transfers of the three-way syringe. Most critical incidents occurred with equal frequency and were common to both rooms, but some were related to instrument location. The subjective responses indicated that the assistant working with the 12-o'clock instrument location had many more tasks and must be more highly trained.


Nasolabial cyst: report of case.

A case of a nasolabial cyst in a woman has been presented; this case adds to the findings that the majority of these lesions are seen in women. The diagnosis of the lesion was complicated by the presence of a radiolucent lesion, and this required the inclusion of other lesions in the differential diagnosis. The presence of S aureus, considered as normal nasal flora, precluded the use of a radiopaque contrast medium to delineate the presence of a nasolabial cyst. Surgical removal of the cyst has achieved a satisfactory result.


Women in dentistry--a review of the literature.

In the dental profession, the percentage of women has not changed appreciably over the last 50 years. Today, about 3.5% of the nation's dentists are women. In 1920, 3% of the dentists in this country were women. This review will examine some of the issues as they pertain to women in dentistry and as they refer to these topics: the situation of female dental students and female dentists in this country; reasons why more women are not attracted to dentistry; and suggestions for recruitment efforts to increase the number of women in the dental profession.


Instructions for patients--a positive factor in removable partial denture service.

Studies have shown that improper wearing and care of removable partial dentures may adversely affect abutment teeth and associated periodontal tissues. A comprehensive removable partial denture service should include not only accurate construction of the prosthesis, but also printed instructions for the patient. Printed instructions help to inform the patient that delivery of removably partial dentures is only a part of our health service designed to maintain good oral health. A text of such concise printed information and instructions for the patient is presented.


The individual with a pacemaker in the dental environment.

A systematic examination of the potential hazards of electromagnetic interference with pacemakers in patients in the dental environment was carried out with the use of several pulse generators of three manufacturers. Only one model was affected by the dental operatory equipment tested. In two of three patients 2-second periods of asystole were noted: this was accompanied by symptoms in one. Permanent pacemakers implanted in three dogs were unaffected by short or sustained stimulation with pulp vitality testers. A permanent pacemaker implanted in one dog was unaffected by short or sustained stimulation with an ultrasonic cleaner. Reliance on severe symptoms alone is a poor method of assessing interference in the clinical situation. Guidelines for protection of the patient wearing a pacemaker in the dental environment are given.


A two-year clinical dental evaluation of 200 cases of chronic headache: the craniocervical-mandibular syndrome.

The procedure of diagnosis of temporomandibular joint dysfunction in 200 patients referred from a headache unit is detailed. The condition is viewed as an orthopedic imbalance, and occlusal therapy and the administration of muscle relaxants are used in treatment.


An analysis of 1,331 sedations using inhalation, intravenous, or other techniques.

The safety and efficacy of various sedative techniques was studied. Inhalation sedation provided the mainstay of anxiety control, whereas intravenous and combination techniques were reserved for more difficult patients or procedures. Pooled data from all techniques yielded an 87% effectiveness rate and 93% patient acceptance rate. Sedation was less often effective in persons with poorer health status than in healthy persons. Complications encountered were few, rarely of serious potential, and easily managed. Nitrous oxide sedation was effective 88.5% of the time and usually at concentrations of 50% or less. The safety and efficacy of intravenous, oral, combination, and especially inhalation sedation given by individuals not formally trained in general anesthesia appears to be confirmed. No correlation of side effects to a specific technique of administration or to patients suffering significant medical disorders could be established. However, more data need to be obtained in this area before firm conclusions can be made.


A new, surface-antigen-adsorbed influenza virus vaccine. I. Studies on immunogenicity in hamsters.

The ability of a new, surface-antigen-adsorbed influenza virus vaccine to induce serum antibody in hamsters, and to protect these hamsters against subsequent homologous virus challenge, is reported. In addition, similar studies in hamsters have also been carried out using the surface antigen material prior to adsorption to the aluminium hydroxide carrier. The new, adsorbed vaccine is at least as effective as inactivated saline influenza virus vaccine in inducing serum antibody and protection in hamsters; the unadsorbed surface antigen material, however, did not confer protection to hamsters challenged subsequently with homologous virus.


A new surface-antigen-adsorbed influenza virus vaccine. II. Studies in a volunteer group.

A group of 23 volunteers were each inoculated with 600 CCA of a new form of influenza virus A/England/42/72 vaccine; this vaccine consisted of purified haemagglutinin and neuraminidase antigens adsorbed to alhydrogel. No significant reactions to the vaccine were reported. Twenty-two volunteers produced increased titres of serum HI antibody, and all showed increased titres of NI antibody after immunization. Thus, for volunteers with no pre-immunization serum HI antibody, the geometric mean titre of serum antibody increased from 1/5 to 1/196 after immunization. Ten volunteers developed local neutralizing antibody after immunization; this antibody response was detected most frequently in volunteers who showed the greater serum antibody response to immunization, and in nasal washings with the higher concentrations of protein and IgA. Ten weeks after immunization, the vaccinees and a group of matched controls were inoculated intranasally with attenuated A/England/42/72 virus. Evidence of infection with the challenge virus was found in 14 of the control subjects and in one of the vaccinees. The results indicate that the surface-antigen-adsorbed vaccine induced high titres of serum antibody, and gave significant protection against challenge infection.


Characteristics of a Kenyan camelpox virus.

A virus was isolated from pock-like vesicular eruptions of camels in Northern Kenya. This virus was shown to be a pox virus with many characteristics of members of the Orthopox group. It appears to be identical with camelpox strains from Iran and has similar properties to certain East African variola strains.


Type-specific action of vibriocidal antibody on Vibrio cholerae.

The vibriocidal activity of Inaba and Ogawa antisera, from which cross-reacting agglutinin had been absorbed, was specific for Vibrio cholerae strains of the homologous serotype. No vibriocidal action against strains of the heterologous type was detected. The sera appeared to be equally effective in killing organisms of different biotypes (classical, intermediate, and EITor), provided that these were of the homologous serotype (Inaba or Ogawa). However, they had been raised against strains of the classical biotype only; and sera resulting from immunization with other biotypes had not been prepared. The implications of these findings in immunity to cholera are discussed.


Persistence of antibody induced by rubella vaccine (Wistar RA 27/3 strain) after six years.

A total of 21 rubella seronegative children vaccinated subcutaneously with Wistar RA 27/3 strain live attenuated rubella vaccine in a family study of vaccine virus transmissibility were reviewed after 6 years. Haemagglutinating inhibiting (HAI) antibody titres of sera collected 46 days, 2 years and 6 years after vaccination were compared. Antibody titres in the vaccinated subjects were not significantly influenced by time, infection in susceptible siblings or revaccination.


Comparative trials of live attenuated and detergent split influenza virus vaccines.

Comparative clinical trials of live attenuated and detergent-split subunit influenza virus vaccines were undertaken with 1048 volunteers in Western Australia. Volunteers were divided into three main groups, each of which received either live virus vaccine or a saline control administered intranasally, or subunit vaccine injected subcutaneously. No differences were recorded between the three groups in their post-vaccination symptoms. Serum samples were collected at various times up to 50 weeks after vaccination, and antibody titres were measured by haemagglutination-inhibition (HI) tests and, for 231 volunteers, by virus neutralization tests. The two vaccines were almost equivalent in inducing seroconversion in vaccinees with pre-trial HI titres of 96 or less, but the subunit vaccine stimulated a higher geometric mean HI antibody titre. The longevity of the HI antibody response was greater for the live virus vaccine. The height of the response and the longevity of neutralizing antibody were the same for both vaccines. Both vaccines provided a high degree of protection against epidemic A/England/42/72 influenza, and some protection against A/Port Chalmers/1/73 influenza.


Airborne infection in a fully air-conditioned hospital. IV. Airborne dispersal of Staphylococcus aureus and its nasal acquisition by patients.

Studies in a newly built hospital furnished with complete air conditioning where most of the patients are nursed in 6-bed rooms showed that the transfer of air from one patient room to another was very small, especially when there was substantial flow of air in a consistent direction between the patient rooms and the corridor, and that the direct transfer of airborne particles was even less. There was, however, no evidence of any reduction in the rates of nasal acquisition of Staphylococcus aureus compared with those to be found in naturally ventilated hospitals. The numbers of Staph. aureus found in the air of a given room that appeared to have originated from patient carriers in other rooms were many times greater than could be accounted for by direct airborne transfer. Although there was evidence that many carriers were not detected, detailed study showed that this excess transfer to the air of other rooms was genuine. It seems probable on the basis of investigations in this hospital and elsewhere that this excess transfer occurs indirectly, through dispersal from the clothing of the nursing and medical staff into the air of another room of strains with which their outer clothes have become contaminated while dealing with patients. Reduction in direct airborne transfer of micro-organisms from one room to another, whether by ventilation or other means, can only be of clinical advantage if transfer by other routes is, or can be made, less than that by the direct airborne route.


Autoclaves and their dangers and safety in laboratories.

Using a laboratory downward displacement vertical autoclave with the help of thermocouples recorded on a 12 point multichannel strip recorder, the risk of failing to sterilize laboratory discard buckets has been demonstrated. The use of proper temperature and time controls can prevent this risk. A load in a bucket with perforated sides is more easily sterilized than in a solid bucket. Wire baskets, where appropriate, facilitate the sterilizing practice. The addition of water to a bucket does not reduce the time of heating up. It is desirable that sealed bottles of media should not be sterilized in simple downward displacement autoclaves, but if used, strict monitoring of temperatures and times is essential both in the heating up stage and especially in the cooling stage. The temperatures in bottles are slow to rise and very slow to fall. Bottles at high temperature 80-105 degrees C. or over have a high internal pressure which can allow the bottles to explode when subjected to thermal shock if removed too early. It is suggested that all laboratory autoclaves should have a load temperature simulator or similar device to control the temperature of the load during the cycle automatically. For the sterilization of fluid media, it is suggested that, in addition to a simulator there should be accelerated cooling to reduce damage to the media and, what is more important, to rapidly bring down the temperature and thus the internal pressure in the bottles to a safe level. The opening of the sterilizer door or lid should be automatically controlled by the load temperature simulator.


Amnion autografts, permanent structure.

Autografts of amniotic membrane were used to form tubes or conduits in lambs. These conduits survived for periods up to 9 months. The possibility of a clinical application has been explored.


Tumor-specific transplantation immunity to intracerebral challenge with cells from a methylnitrosourea- induced brain tumor.

Tumor-specific transplantation immunity was demonstrated in syngenic rats immunized and challenged with tumor cells (T9) from an N-methyl N-nitrosourea-induced brain tumor. All unimmunized rats and rats pretreated with normal glial cells in complete Freund's adjuvant or with adjuvant alone died of intracerebral (i.c.) neoplasia at approximately 3 weeks post-challenge. Rats which were immunized with T9 cells with or without adjuvant failed to develop i.c. tumors by 6 weeks even though the challenge dose was 2 logs greater than a dose which consistently resulted in neoplasia in unimmunized rats.


Erythropoietin activity in acutely uremic mice.

Erythropoietic activity produced by exogenous erythropoietin (Ep) is markedly reduced in Swiss mice rendered uremic by bilateral nephrectomy or bilateral ureteral ligation. Exogenous Ep causes a greater increase in erythropoiesis in germfree Swiss mice as compared with non-germfree mice, but the germfree mice show a more drastic reduction of erythropoiesis in uremia. Heme production in blood, spleen, and femoral marrow retains its typical pattern in uremia; there is no shift of erythropoiesis among the three sites. Production of endogenous Ep in uremic mice is less by a factor of 2-3 than that in intact mice whereas the reduction is by a factor of almost 100 in anephric mice. The data suggest that the anemia associated with uremia is the result of two phenomena: (1) a decreased production of Ep and (2) a diminished erythropoietic response to Ep.


Lupoid hepatitis, Rendu-Osler-Weber syndrome, clubbing cyanosis and hypertrophic osteoarthropathy.

Chronic liver disease typical of chronic active 'lupoid' hepatitis together with cyanosis, clubbing and hypertrophic osteoarthropathy in a 42-year-old female is described. In addition she had severe nose bleeds, gastro-intestinal haemorrhages, syncopal attacks with generalised convulsive seizures, pulmonary arterio-venous fistulae as manifestations of Rendu-Osler-Weber syndrome. A study of the literature revealed that similar associations are far more frequent than can be attribtued to chance. Possible mechanisms of the cyanosis, clubbing and osteoarthropathy and possible common pathogenesis for these seemingly unrelated disorders are discussed.


Primary osteogenic sarcoma of the brain. Case report.

The authors report a case of primary osteogenic sarcoma of the brain. Negative autopsy findings, complete bone radiographs, and bone-scanning techniques were consistent with a primary tumor focus in the right temporopietal region of the brain. The authors suggest an origin from a primitive multipotential mesenchymal cell.


Augmented radioactivity on bone scans of limbs bearing osteosarcomas.

Thirteen patients with biopsy-proven osteosarcomas were studied with 99mTc-labeled bone-scanning agents. In addition to the dense areas of abnormal uptake corresponding to the tumors, ten patients exhibited a relative increase of radioactivity at the ends of the long bones of the affected extremities. Several of these areas were included in the surgical specimens but no tumor cells were found.


Salivary gland carcinoma of the palate.

Results of a detailed study of the clinical features, histology, management, and prognosis of palatal carcinoma of salivary origin in 30 patients are presented. These were compared to a larger series of salivary carcinoma at other sites, and to the known behavior of epidermoid carcinoma of the palate. The prognosis was significantly better for lesions of the palate. Results of treatment were also much better for these salivary gland lesions than for epidermoid carcinoma of the palate. The frequent occurrence and seemingly greater malignancy of adenoid cystic carcinoma at this anatomic site are stressed. Several patients with primary bone involvement survived, but local recurrence in the maxilla carried a graver prognosis. There was no definite indication that radiotherapy altered the course of the disease, and nothing to suggest that prophylactic neck dissection is of value. On the basis of the evidence presented, there is little to justify more radical excision than the clinical extent of the lesion would indicate, with the probable exception of adenoid cystic carcinoma, where a more aggressive approach may well prevent death from cancer.


Management of orofacial infection in patients with chronic renal disease.

Chronic renal failure with resulting imbalance of electrolytes complicated the treatment of a patient with acute facial cellulitis that resulted from a carious molar. The patient's condition improved significantly after three days of hospitalization with meticulous medical and surgical care. He was able to return home after five days.


Survival of an oral surgery patient with malignant hyperthermia.

Malignant hyperthermia is a life-threatening complication of general anesthesia. Its cause is not precisely known but it appears to be related to a genetic defect that allows increased release or decreased reaccumulation of calcium by the sarcoplasmic reticulum whech then results in a hypermetabolic state. As with any unexpected complication when a patient is  under general anesthesia, early diagnosis and treatment are essential. The early clinical signs that the surgeon and anesthesiologist shoulc be alert to are unexplained tachycardia, unexplained tachypnea, muscular rigidity, and increased temperature. Therapy should be accurate and immediate. The essentials of therapy are discontinuance of the anesthetic agent; immediate, active, and aggressive cooling; administration of procaine or procaine amide, 1 mg/kg/min until the pulse slows; correction of electrolyte and acid-base imbalances; maintenance of urinary output with furosemide and large volumes of fluids, intravenously; and supportive care. A thorough knowledge of the management of malignant hyperthermia ahd the pathophysiology of the complications that may occur with general anesthesia will allow the oral surgeon to fully meet his obligations to his patients.


Transport and storage of human teeth in vitro for autotransplantation and replantation.

A method has been devised for transporting and storing human teeth in vitro for autotransplantation and replantation. In the transplantation and replantation of accidentally lost teeth, the viability of the cells covering the root is of vital importance. Injury of the jaw and contamination of the tooth often prevent immediate replantation. To enable transportation and storage of teeth while maintaining viability of the periodontal ligament during the healing period after trauma, the following technique was worked out. With use of a transport medium and a tissue-culture technique, 35 human teeth were transported long distances (20 hours) to a tissue-culture laboratory and preserved for different periods of time. Three teeth were lost because of contamination. Twenty-one of the teeth were cultivated in tissue-culture medium at 37 C for four weeks; 11 of the teeth were stored in liquid nitrogen at -196 C for 27 weeks. After transportation and storage, it was possible to maintain the viability of the cells of the periodontal membrane of the teeth. Two cases are described wherein immediate transplantation and replantation were impossible. After transport to the laboratory, the teeth were stored for five weeks in one case and for three months in another case before replantation.


Soft tissue changes associated with total maxillary advancement: a preliminary study.

A retrospective investigation was performed with use of cephalometric radiographs from eight patients with anterior maxillary advancement. Soft tissue changes associated with hard tissue changes were measured. Statistical description of soft tissue behavior in the upper lip was performed using correlation coefficients, regression functions, and ratios of change in the relationship of soft tissue to hard tissue. Ratios of change in relationship of soft tissue to hard tissue for three parameters of upper lip movement are proposed for clinical use in treatment planning. Further investigation of soft tissue behavior with orthognathic surgical procedures is indicated.


Variation of the sella-nasion plane and its effect on SNA and SNB.

The sella-nasion plane is one of the basic planes used in the cephalometric evaluation of candidates for orthognathic surgery. The relationship between SN and the Frankfort horizontal plane was studied. It was shown that as the angle between FH and SN increases, the SNA and SNB angles decrease in the normal individual. Compensation can be made for this variation by using the values presented.


Epidermolysis bullosa and associated problems in oral surgical treatment.

The problems encountered in the anesthetic and oral surgical management of patients with epidermolysis bullosa are many and varied and are always challenging. Two patients with the disease, from the same family, underwent complete odontectomies. Exacerbation of the disease was prevented by hospitalization with meticulous preparation and exacting postoperative care. This is the first report in the dental literature of complete odontectomies performed on two afficted patients from one family.


Alveolar soft-part sarcoma in the oral cavity: report of a case.

This case presents a rare tumor of the oral cavity--an alveolar soft-part sarcoma. Difficulties developed in the diagnosis, and therefore, consultations were required. Because of the radioresistant qualities of the lesion, wide surgical excision was performed. The patient's condition has been followed for 40 months without evidence of recurrence. The conclusion arrived at from review of the literature is that this is an indolent but malignant tumor and has so far proved to be 100% fatal. However, it may be 20 years before it proves fatal.


Chain saw injury of the mandibulofacial region.

Use of chain saws is hazardous. Public understanding of the hazards and of modern types of chain saws will eventually help in preventing these injuries. An injury of the mandibulofacial region resulting from a chain saw has been described with special emphasis on preoperative, intraoperative, and postoperative management.


Candida arthritis treated with amphotericin B.

This report describes a patient with acute lymphoblastic leukemia who developed arthritis of the knee caused by Candida tropicalis. Systemic therapy with amphotericin B apparently suppressed but did not eliminate the infection. Resolution of the arthritis occurred only after three intra-articular injections of amphotericin B. Intra-articular administration of amphotericin B may be a useful adjunct to systemic antifungal therapy in the treatment of these infections.


The effect of tissue resiliency on occlusion in complete denture prosthodontics.

(1) The resiliency of the soft tissues has an effect on the occlusion of artificial teeth in complete denture prosthodontics. (2) Remount procedures with unstrained and strained interocclusal records are usually necessary to demonstrate this effect and alter the occlusion.


Effects of artifical crown margin extension and tooth brushing frequency on gingival pocket depth.

The gingival tissues adjacent to the crowned and unrestored teeth were probed to determine individual pocket depths. The findings are listed here. (1) The average pocket depth adjacent to nonrestored teeth was 2.7 mm. The average pocket depth adjacent to teeth having crowns with subgingival margins was 3.4 mm. (2) Fifty-four nonrestored teeth had at least one pocket depth greater than 3 mm., while 84 crowned teeth had at least one or more measurements greater than 3 mm. (3) No positive relationship could be found between tooth brushing frequency and the pocket depth adjacent to teeth restored with complete cast crowns. (4) In nonrestored teeth, pocket depth increased with reduced frequency of tooth brushing. (5) Pocket depth increased with increased age of (a) the patient in both restored and nonrestored teeth and (b) the cast crown.


Cranial implant problems.

The common problems encountered during cranioplasty procedures have been reviewed and remedial procedures suggested. The problems or situations discussed include: implant selection and impressions, swelling and infection, integument thickness, distortion of plastic implants by autoclaving and seating guides, control of bleeding and swelling during operation, implant immobilization, eyebrow area involvement, dropping the implant, and inadequate skin flaps.


Differences in the response of rodent oral mucosa and skin to repeated surface trauma.

The responses of oral mucosa and skin to daily application of controlled frictional stimuli were compared. In some respects, the epithelia of both oral mucosa and skin showed similar responses: Low levels of friction resulted in epithelial thickening, and higher levels resulted in ulceration. The mucosa, however, ulcerated more readily and, unlike the skin, failed to heal if friction was reapplied. The histologic appearance of the ulcers so produced was essentially similar to that of denture-induced traumatic ulcers. Healing of ulcerated skin was associated with the formation of a hard surface scab which protected the underlying healing tissues from further frictional damage. A similar protective scab was not formed over mucosal lesions, and a thickened epithelium resistant to further frictional damage was not re-formed. The low resistance of the oral mucosa to friction and its failure to heal if friction is reapplied suggest that an analogy between the responses to friction of oral mucosa and the skin does not form a sound basis for clinical therapy.


Cast arch bars used in orthognathic surgery.

Cast arch bars are designed so that they are stable, comfortable, thin, and strong enough to withstand the forces of mastication during healing. The use of chromecobalt alloys for these arch bars keeps the cost low. The alloys are well tolerated by the patient and not as cumbersome as acrylic resin splints.


Dihydrofolate reductase from Eimeria tenella: rationalization of chemotherapeutic efficacy of pyrimethamine.

Dihydrofolate reductase activity of 0.2 nmole of dihydrofolate reduced/min/mg protein was detected in crude extracts of unsporulated oocysts of Eimeria tenella. The enzyme was purified by a combination of affinity and ion-exchange chromatography. Its molecular weight was estimated as 240,000 daltons. An anticoccidial drug pyrimethamine is a potent inhibitor of the activity of E. tenella dihydrofolate reductase (Ki = 3 nM), but it is less effective an inhibitor of dihydrofolate reductase from chicken liver. This difference may explain the in vivo therapeutic action of pyrimethamine against Coccidia.


7-substituted actinomycin D analogs. Chemical and growth-inhibitory studies.

The synthesis and biological activity of three 7-substituted actinomycin D derivatives are reported. Three such derivatives, 7-nitro-, 7-amino-, and 7-hydroxyactinomycin D, were synthesized via new methods which were first tested successfully with a chromophore model system. Of these, 7-nitro- and 7-aminoactinomycin D were assayed for growth inhibitory activity against mammalian cells (CCRF-CEM human lymphoblastic leukemia) in vitro and against the Ridgway osteogenic sarcoma and the L1210, P1534, and P388 murine leukemias in vivo. In these systems, the inhibitory activity of the 7-substituted analogs was comparable to actinomycin D. In two bacterial systems ( (L. casei and L. arabinosus) in vitro, on the other hand, these compounds showed inhibitory profiles which are distinctly different from actinomycin D. These studies demonstrate that substitution at the 7 position, which does not interfere with DNA binding, is capable of yielding experimental antitumor agents with significant activity against a variety of tumors.


[A case of loa-loa filariasis (author's transl)].

A report about a case of loa-loa filariasis whereby after removal of a female worm out of the subconjunctival space no microfilariae but a schisslike edema of the attacked eye's retina was found. In this connection the author gave some observations on the particularies of loa-loa filariasis.


[The development of the cytological picture of the oral cavity during radiation therapy].

On the basis of a personal series, stress is laid on the importance of the cytodiagnosis of the oral cavity during the therapeutic stage of neoplastic lesions. Development and responses to therapy can be followed clearly and simply.


[A case of maxillary metastasis from breast cancer].

The literature data relating to the jaws as a metastasis site are examined, along with the basic criteria and main symptomatological pictures observed. A personal and relatively unusual instance of metasis to the upper jaw from breast cancer is presented. The features that led to diagnosis are discussed. Reference is made to the reported theories that justify the rarity of metastasis from breast cancer to the maxillofacial bones.


[Dentistry and auxology. Preliminary note].

The relationship between dental disease and auxology is again discussed. Work at the "G. de Toni" Auxology and Neaniology Centre is discussed, including a case of pachysomic nanism described in 1957 by Prof. Lagonigro. Attention is drawn to the importance of the relationship, often overlooked by physicians. Further notes on other cases of dental disease in subjects with auxiopathies are promised.


[Considerations on local-regional anesthesia for ambulatory tooth extractions in patients with heart disease].

Ambulatory dental extraction was performed on 150 patients with various forms of heart disease. No serious complications were noted with an anaesthetic without vasoconstriction (plain 3% carbocaine). The prior history was carefully studied and pressure values were determined. It is felt that heart disease does not form an absolute contraindication to ambulatory dental extraction.


New characteristics of harmaline inhibition of intestinal transport systems.

Harmaline strongly inhibits the uptake of phenylalanine by slices of guinea-pig intestine in vitro. The lowest concentration having a significant effect is 0.1 mM. The drug also inhibits the unidirectional flux of phenylalanine from the mucosal to serosal face of the tissue provided it is added to the solution bathing the mucosal surface. The unidirectional flux of sodium from the mucosa to the serosa was similarly reduced. Ion and water absorption in the perfused dog intestine in vivo is also diminished in the presence of harmaline. These results support the hypothesis, previously proposed in view of the rapid onset of harmaline inhibition of sodium-dependent uptake mechanisms in a variety of tissues, that harmaline interacts with the sodium-site of non-electrolyte carrier complexes. The effect of harmaline on phenylalanine uptake by the intesting is duplicated by other psychotropic indole analogues. The actions of harmine and harnalol are similar to that of harmaline, despite great differences in the liposolubility of the different compounds. N:N-dimethyl-tryptamine is equally inhibitory, but serotonin is inactive. Mescaline and lysergic acid diethylamide also inhibit phenylalanine transport, but to a much lesser extent than harmaline.


Blastic leukemias affecting mammary glands.

Two clinical cases of blastic leukemia with tumorous infiltration of mammary gland are presented. Literature data and diagnostic problems of this type complication are discussed.


Comparative sensitivity of penicillinase producing Staphylococcus aureus to four cephalosporin antibiotics.

One hundred and seven strains of penicillinase producing Staphylococcus aureus were tested for their sensitivity to four cephalosporin antibiotics--cephalothin, cephaloridine, cephradine and cephalexin. All the strains were sensitive to these antibiotics. Cephaloridine was the most effective antibiotic and cephradine the least effective as measured by their minimum inhibitory concentration. Varying the inoculum size had no significant effect on the MIC of cephradine.


The establishment of decentralised accident teams in Christchurch.

The organisation, method of operation and evaluation of decentralised medical accident teams established in Christchurch is described. Results from a pilot study undertaken over two years in one area of Christchurch to assess the need for the establishment of these units are documented. The problems associated with communications, equipment and training for this work are discussed.


The partogram: a graphic guide to progress in labour.

The use of the partogram of Philpott, Studd, has proved to be a very valuable aid in the early detection of abnormal progress in labour. The graphic representation of all the relevant data of the labour on one sheet of paper has been received enthusiastically by the nursing and medical staff alike and has allowed the earlier detection of abnormal patterns of labour. It is considered that the partogram should become an essential part of the documentation of labour in all patients.


Validity of corrections for creatinine excretion and creatinine clearance.

Corrections of values for creatinine excretion and creatinine clearance on the basis of body weight reduce the population variation, i.e., narrow the reference range. The range is not further narrowed, however, by correcting for calculated surface area or calculated lean body mass. Corrections of creatinine clearance for body weight and calculated lean body mass remove the sex difference seen in the uncorrected clearances, but creatinine clearance corrected for surface area, although not significantly different between the sexes, give appreciably different reference ranges. These conclusions apply to individuals healthy in terms of body composition.