In vitro transcription of chromatin in the presence of a mercurated nucleotide. Mercurated uridine triphosphate has been used to label transcripts of chicken reticulocyte chromatin made with Escherichia coli RNA polymerase. The mercury-labeled RNA product can be completely separated from endogenous RNA sequences in the chromatin by passage through a sulfhydryl Sepharose column. Globin cDNA hybridization to the transcript shows that only 2.6 x 10-5 of the transcript is globin RNA. In contrast to this result, erythrocte chromatin transcript contains less than one tenth as many globin RNA sequences.


Long-chain neutral glycolipids and gangliosides of murine fibroblast lines and their low- and high-tumourigenic hybrids. The patterns of long-chain neutral glycolipids and gangliosides of established, L-cell-derived murine fibroblast lines and their low- and high-tumorigenic hybrids were studied.


Presence of messenger specifying sequences in the DNA of chromatin subunits. Messenger-specifying sequences in subunits of human lymphocyte chromatin were detected by hybridization of DNA complementary to cytoplasmic polyadenylylated RNA with DNA isolated from the subunits. Comparison of the kinetics and extents of hybridization of complementary DNA with chromatin subunit DNA and with nuclear DNA showed that most of the repetitive sequences and single copy sequences in mRNA are present in chromatin subunits. This result indicates that inclusion of a DNA sequence into the subunit does not prevent its transcription in vivo.


Nuclear magnetic resonance study of heme-heme interaction in hemoglobin M Milwaukee: implications concerning the mechanism of cooperative ligand binding in normal hemoglobin. Hemoglobin M Milwaukee (beta 67E11 val leads to Glu) is a naturally occurring valency hybrid containing two permanently oxidized hemes in the beta-chains. In this mutant, the two abnormal beta-chains cannot combine with oxygen, whereas the two alpha-chains are normal and can combine with oxygen cooperatively with a Hill coefficient of approximately 1.3. High-resolution proton nuclear magnetic resonance spectroscopy at 250 MHz has been used to investigate the hyperfine shifted resonances of the abnormal ferric beta-chains of Hb M Milwaukee over the spectral region from -30 to -60 parts per million from water at pD 7 and 30 degrees.


Hepatic phenylalanine 4-monooxygenase is a phosphoprotein. Phenylalanine hydroxylase [phenylalanine 4-monooxygenase; EC 1.14.16.1; L-phenylalanine, tetrahydropteridine:oxygen oxidoreductase(4-hydroxylating)] isolated from rat liver is a phosphoprotein containing approximately 0.31 mumol of  protein-bound phosphate per mumol of subunit (50,000 molecular weight). When the enzyme is further phosphorylated in the presence of ATP and a 3'5'-cyclic-AMP-dependent protein kinase (EC 2.7.1.37; ATP:protein phsophotransferase), an additional 0.7 mumol of phosphate per mumol of subunit is introduced, bringing the total phosphate content up to about 1 mumol/mumol of subunit. This phosphorylation of the enzyme in vitro is accompanied by a 2.6-fold increase in hydroxylase activity when the activity is assayed in the presence of tetrahydrobiopterin. Partial proteolytic digestion of phenylalanine hydroxylase, which previously had been shown to activate the enzyme 20- to 50-fold [Fisher, D.B. & Kaufman, S. (1973) J. Biol. Chem. 248, 4345-4353], removes almost all of the phosphate from the enzyme.


An enzyme system for replication of duplex circular DNA: the replicative form of phage phi X174. Viral single strands (SS) are converted to the duplex from (RF) by a soluble enzyme fraction uninfected Escherichia coli [Schekman et al. (1975) J. Biol. Chem. 250, 5859-5865]. When reactions were supplemented with a soluble enzyme fraction from phi X174-infected cells, replication of phi X174 superhelical RF I DNA was observed. The activity supplied by infected cells was absent in cells treated with chloramphenicol or in cells infected with a phi X174 phage mutant in cistron A (cis A). A host function coded by the rep gene, essential in vivo for RF replication (but not for SS leads to RF), was supplied by enzyme fractions from either infected or uninfected cells. Based on complementation assays, the cisA-dependent and the rep-dependent proteins have each been purified about 1000-fold. The synthetic products of the enzymatic reaction were identified as RF I and RF II in which viral (+) and complementary (-) strands were newly synthesized.


Inelastic electron tunneling spectroscopy of nucleic acid derivatives. Inelastic electron tunneling spectra of nucleosides and nucleotides are presented which show that detailed information on the vibrational spectra of these molecules can be obtained from a few micrograms of material. A series of studies on adenine derivatives demonstrates that unambiguous identification of a large number of slightly different derivatives can be carried out by means of this technique.


Cell cycle analysis and X-chromosome inactivation in the developing mouse. The duration of different phases of the cell cycle (G1, S, G2, and M), as well as the exact time of initiation of asynchronous DNA replication pattern in one of the X-chromosomes in the female mouse during the early stages of development, have been investigated. It was found that early developmental stages in the mouse are devoid of G1 period, and from the late blastocyst stage the embryonic cells first acquire all the characteristic stages of the cell cycle (G1, S, G2, and M). Additionally, asynchronous DNA replication pattern in one of the X-chromosomes in the female embryos was found to be initiated with the appearance of the G1 period. I have established a correlation between the onset of the G1 period and the initiation of an asynchronous DNA replication pattern in one of the X-chromosomes of the female mammal during embryogenesis.


Stimulation of prostaglandin E synthesis in cultured human umbilical vein smooth muscle cells. Cultured human umbilical vein smooth muscle cells secreted 1.26 +/- 0.20 mug of immunoreactive prostaglandin E (iPGE) per mg of cell protein per 24 hr (mean +/- SEM). In indomethacin, an inhibitor of prostaglandin synthesis, abolished greater than 95% of this basal iPGE production (ID50 = 1.8 nM).


An evaluation of messenger RNA competition in the shutoff of human interferon production. The process that shuts off poly(I)-poly(C)-induced interferon production in a strain of diploid human fibroblasts (FS-4)-involves the synthesis of new RNA, presumably nuclear heterogeneous RNA. When cultures in the shutoff phase of interferon production are treated with actinomycin D (5 mug/ml) or 5,6-dichloro-1-beta-D-ribofuranosylbenzimidazole (DRB 40 muM), the rate of interferon production continues to decline for a further 3-4 hr, but then tends to level off. The treated cultures maintain interferon production at a reduced level for at least 10 hr. The residual rate of interferon production is higher in cultures which received actinomycin D or DRB early in the shutoff phase as compared to the rate in cultures treated late.


Alpha-methyl ornithine, a potent competitive inhibitor of ornithine decarboxylase, blocks proliferation of rat hepatoma cells in culture. A biphasic increase of putrescine concentration occurs in rat hepatoma tissue culture cells induced to proliferate. DL-alpha-Methyl ornithine, a competitive inhibitor of ornithine decarboxylase ( L-ornithine carboxylyase, EC 4.1.1.7) of hepatoma tissue culture cells, blocks the usual increases of putrescine and spermidine concentrations in these cells, and causes a rapid fall in the levels of putrescine which is followed by a striking decrease of spermidine. In parallel with the depletion of these amines, incorporation of [3H]thymidine into DNA and cell proliferation are inhibited. Addition of putrescine, spermidine, or spermine results in an immediate resumption of cell proliferation. Cell proliferation is also restored by L-ornithine presumably due to in situ competitive inhibition of ornithine decarboxylase. These findings of hepatoma tissue culture cells support the concept that polyamines play an essential function in the cell division processes.


Fluidity in mitochondrial membranes: thermotropic lateral translational motion of intramembrane particles. The fracture faces of frozen rat liver mitochondria reveal that intramembrane particles can be induced to under go long-range lateral translational motion and aggregation, which parallel the appearance of large, particle-free smooth patches in the hydrophobic interior of the two mitochondrial membranes. These lateral separations were observed under conditions that induce thermotropic lipid-lipid phase separations. Low temperature-induced lateral separation occurred between the intramembrane particles (integral proteins) and smooth patches (bilayer lipid) at temperatures between about 10 and -12 degrees in the outer membrane and between about -4 and -12 degrees in the inner, energy transducing membrane.


The development of the action potential mechanism of amphibian neurons isolated in culture. Nerve and muscle cells differentiated morphologically, in cultures of dissociated cells prepared from amphibian neural plate and underlying mesoderm (Xenopus laevis, Nieuwkoop and Faber stage 15). Cultures were grown in a defined medium containing sterile Steinberg's salt solution and 0.1% bovine serum albumin, and maintained for periods up to 5 days.


Distribution of annionic sites in glomerular basement membranes: their possible role in filtration and attachment. Lysozyme (pI = II) has been used to identify anionic sites in the glomerular capillary wall. A solution of 1-3% lysozyme was perfused into the left kidney at varying rates. After perfusion, the kidney was fixed in situ and processed for electron microscopy. Lysozyme was seen as an electron-dense deposit which was not present when succinylated lysozyme (pI = 4.5) or myoglobin (pI = 6.9) was perfused instead of native lysozyme. First, the epithelial cell plasma membrane was outlined by a 300-400 A electron-dense layer. Second, there were discrete dense deposits in the subepithelial portions (lamina rara externa) of the basement membrane which, in normal sections, extended from the epithelial cell membrane to the lamina densa and, in grazing section, formed a continuous reticular pattern.


Different calcium requirements for proliferation of conditionally and unconditionally tumorigenic mouse cells. Conditionally tumorigenic BALB/3T3 mouse cells (which produce tumors in BALB/c mice only under special conditions) cannot sustain DNA synthesis and consequently stop proliferating in media containing low concentrations (0-0.02 mM) of physiologically available calcium. By contrast, cells that have been neoplastically transformed (tumorigenic in mice without special assistance) in vitro by different oncogens, can sustain DNA synthesis and proliferate in such calcium-deficient media. The possible importance for tumor growth of an ability to withstand calcium deprivation is examined. It is suggested that this property may prove to be a reliable indicator of neoplastic transformation.


Multiple active forms of thrombin: binding to platelets and effects on platelet function. The effect of various forms of thrombin on certain platelet functions has been investigated. Partially purified bovine thrombin which is a mixture of multiple active forms of thrombin, was chromatographed to yield molecular species termed alpha-, beta-, and gamma-thrombin, each of which has varying degrees of fibrinogen clotting and esterase activities. A direct correlation was observed between the ability of the different forms of thrombin to clot fibrinogen and to influence platelet function. In general, thrombin with high fibrinogen clotting activity was also a potent inducer of platelet aggregation and the release reaction, while those species with low clotting ability were poor inducers of aggregation and release.


Changes in type of collagen synthesized as clones of chick chondrocytes grow and eventually lose division capacity. Clones of embryonic chick chondrocytes have been isolated and collagen biosynthesis has been followed as the clones grow and eventually lose division capacity. Analysis of collagen type at each successive subculture until the time of cellular senescence has shown that a change in synthesis occurs from the cartilage-specific Type II collagen (chain composition [alpha1(II)]3) to a mixture of Type I collagen (chain composition [alpha1(I)2alpha2) and the Type I trimer (chain composition[alpha1(I)]3). The results demonstrate unequivocally that the expression of the chick chondrocyte phenotype is unstable in vitro, and that previous experiments with mass cultures of chondrocytes cannot be accounted for by overgrowth of fibroblasts. Since similar morphological changes and a similar "switching" in collagen biosynthesis have been observed after growth of chondrocytes for a few days in 5-bromo-2'-deoxyuridine, it is proposed that growth in this analog accelerates those changes that eventually lead to cellular senescence.


Evolution of continuous variation: direct approach through joint distribution of genotypes and phenotypes. The evolutionary dynamics of the joint distribution of genotypes and phenotypes is studied. The model, originally devised to study the joint effects of Mendelian and other types of transmissions, provides results of interest also to the theory of direct Mendelian transmission with natural selection. Assuming bivariate normal distributions, it is shown that in the latter case genotypic and phenotypic means and variances, and genotype-phenotype correlation can be expressed recursively as functions of the parameters for the selection, environmental, and mutation variance. Equilibria and rates of approach for these moments are calculated. It is also proved that in the presence of selection the heritability,defined as the ratio of expected genotypic to expected phenotypic variance after selection, is greater than that before selection by a predictable amount and that it can be greater than unity.


Hypersensitivity to tobacco antigen.

Hypersensitivity to tobacco antigen. A glycoprotein of molecular weight 18,000 was purified from saline extracts of cured tobacco leaves by ammonium sulfate fractionation, chromatography on Sephadex G-25 and continuous-flow preparative electrophoresis on polyacrylamide gel. Twelve of 31 volunteers (6/15 smokers and 6/16 nonsmokers) exhibited immediate cutaneous hypersensitivity (wheal and flare reactions) when injected intracutaneously with 2 mug of this material. Immunochemically similar material was demonstrated in, and purified from, cigarette smoke condensate and cigarette smoke. The concentration in cigarette smoke condensate ("tar") was determined to be 1.8-3.6 mg/g. Antigenically crossreactive material was also demonstrated in eggplants, green peppers, potatoes, and tomatoes, which, like tobacco, are members of the family Solanaceae.


The effect of main artery occlusion of one kidney on blood pressure of dogs. Occluding the main artery of one kidney in each of six dogs resulted in an average increase in the renin concentration of the peripheral blood from the original 0.040 to 0.198 milliunit/ml of serum. During the same time (3-4 days), the occlusion also resulted in a significant rise of directly measured mean systemic blood pressure from an average basal level of 104 to 139 mm Hg.


Inhibition of arachidonic acid release from cells as the biochemical action of anti-inflammatory corticosteroids. Serum stimulates the production of prostaglandins by transformed mouse fibroblasts. Hydrocortisone (cortisol) inhibits this stimulation. The half-maximal inhibition occurs at 6x10-9 M. Studies with cells labeled with [3H]arachidonic acid in their lipids show that the stimulation by serum results in the release of arachidonic acid from the cellular lipids, mostly phospholipids. Hydrocrotisone inhibits this release but does not inhibit the production of prostaglandins from exogenously supplied arachidonic acid. This inhibition of arachidonic acid release from phospholipids may be the mechanism for the anti-inflammatory action of corticosteroids.


Kinetics of glucagon in man: effects of starvation. Serum stimulates the production of prostaglandins by transformed mouse fibroblasts. Hydrocortisone (cortisol) inhibits this stimulation. The half-maximal inhibition occurs at 6x10-9 M. Studies with cells labeled with [3H]arachidonic acid in their lipids show that the stimulation by serum results in the release of arachidonic acid from the cellular lipids, mostly phospholipids. Hydrocortisone inhibits this release but does not inhibit the production of prostaglandins from exogenously supplied arachidonic acid. This inhibition of arachidonic acid release from phospholipids may be the mechanism for the anti-inflammatory action of corticosteroids.


Analysis of ion distribution in subcellular myocardial particulates separated by density gradient centrifugation with nonpolar liquid under ion immobilization conditions. Methods have been developed for the measurement of the Ca and Mg contents of subcellular particulates, separated by nonpolar liquid density gradient ultracentrifugation. After rapid deep freezing and removal of water by freeze-drying the frozen crushed tissue, homogenization and sonification a nonpolar liquid were carried out. Application of this technique has yielded evidence that the relative amounts of Mg and Ca are greatly different in the several subcellular particulates of normal heart muscle separated by density gradient centrifugation. It also appears that the comparative specific activity of Ca, after loading the perfusates with 45Ca, is very different in the several density fractions of the normal heart. The density site of greatest loading with 45Ca is changed in Ca2+-lack arrest and is very greatly altered by the induction of paradoxical Ca contracture. The method of ion-immobilization separation for water-free particulates of different densities in nonpolar liquids appears to be applicable to analysis for various constituents of other biological materials.


Apolipoproteins in rat serum and renal lymph. The concentration of apolipoproteins was measured by quantitative immunoelectrophoresis in rat serum, in the lipoprotein-free ultracentrifugal fraction (density greater than 1.21) of serum, and in renal lymph. The A-IV and arginine-rich apolipoproteins were present in high concentrations (greater than 18.5% of serum concentration)  both in the fraction of density greater than 1.21 and in renal lymph, whereas the other apolipoproteins were found in low concentrations ( less than 7% of serum concentration). The major apolipoproteins of renal lymph were similar to those found in the fraction of density greater than 1.21; however, the apolipoproteins composition of the renal lymph was very different from the apolipoprotein composition of serum lipoproteins. The presence of certain apolipoproteins in the fraction of density greater than 1.21 and in renal lymph suggests that these apolipoproteins might be present in the circulation as "free" apolipoproteins. The possible physiological importance of these specific apolipoproteins is postulated.


Effects of cholera toxin on cochlear endolymph production: model for endolymphatic hydrops. To evaluate a possible role for adenylate cyclase [ATP pyrophosphate-lyase (cyclizing), EC 4.6.1.1] and adenosine 3':5'-cyclic monophosphate in the secretion of endolymph, we studied the effect of an intra-scala media injection of purified cholera toxin (an adenylate cyclase stimulant) on cochlear endolymph volume, endolymphatic potential, and endolymphatic Na and K concentrations.


Replication of mycoplasmavirus MVL51: attachment of MVL51 parental DNA to host cell membrane. The replication of the single-stranded circular DNA of MVL51 mycoplasmavirus has been studied with respect to the roles of free and membrane-associated viral DNA intermediates. Replication involves the formation of parental replicative intermediate (RF) molecules on, at most, two to three membrane sites per cell, symmetric RF replication at the membrane and apparent asymmetric RF replication in the cytoplasm leading to single-stranded progeny chromosomes.


[Lymphographic interpretation of benign lymphnodes lesions (author's transl)]. Clinical, lymphographic and morphologic non tumor induced lymphnode lesions of 164 patients are described, and a roentgenographic morphological correlation is performed. Diffuse non specific inflammatory and reactivy lymphnode lesions are divided into three groups. These changes cannot be distinguished from lymphnodes with micrometastases. Typical cirteria for segmental lymphnode fibrosis and hyperplasia are described. Fatty lymphnode degeneration may be segmental or diffuse, their characteristics are presented as well.


Immediate response to expiratory threshold load. In anesthetized rabbits, cats and dogs the end-inspiratory volume referred to normal FRC (deltaVe.i.) of the first breath during expiratory threshold load (ETL) was greater than control deltaVe.i. The increase of deltaVe.i. was roughly proportional to the increase of end-expiratory volume relative to normal FRC (deltaVe.e.) caused by ETL. During squeezing of the rib cage or of the abdomen or after cordotomy at T1 the phenomenon occurred nearly to the same extent. This suggests that afferent impulses from the chest wall are not essential in determining the phenomenon. The first inspiration during ETL occurred after a delay that was roughly proportional to the increase of deltaVe.e: the arterial Pco2, however, was not significantly increased at the time of the first inspiration during ETL. After bilateral vagotomy the first inspiration during ETL was no longer increased. An explantation of the increased deltaVe.i. of the first inspiration during ETL is provided on the basis of the vagal dependent tidal volume-inspiratory duration characteristic of the respiratory center.


Prevalence of gingivitis among children with and without school dental service. In order to evaluate the effect of school dental care on the prevalence of gingivitis in children, two groups of children in the 7th grade (approx. age 13-14 years) were compared, only one of the groups having had school dental service. A  total of 758 children from eight different provincial towns in Denmark were studied. Gingivitis was recorded by the method of Löe & Silness. The results are given as the average sum of sound, inflamed, and severely inflamed gingival zones and in frequency tables. There were only small differences between those children who had had school dental service and those who had never received it.


A radiographic study of mineralization of permanent teeth in a group of children aged 3-7 years. The purpose of the present study was, by using a standardized radiographic technique, to assess the time of selected mineralization stages of all permanent teeth except the second and third molars in a group of 580 children aged 3-7 years. A complete radiographic examination, consisting of nine intraoral films, was made of each child, using Eggen's film holder. According to degree, mineralization of the teeth was subdivided into nine stages. The cap relation between the two variables, mineralization stage and chronologic age, was calculated by linear regression analysis. The hypothesis of the present study, that linearity exists between the two variables, was confirmed within and close to the investigated age group.


Developmental disturbances in permanent teeth after intrusion of their primary predecessors. The frequency and type of developmental disturbances in the permanent teeth in relation to the child's age at the time of injury were examined in 78 patients with 100 intruded primary incisors. The central incisors were found to be the most frequently affected teeth. Only maxillary teeth were involved. The dominating age group was 1-3 years and intrusion was seldom seen after the age of 4 years. The frequency of disturbed normal development of the permanent teeth was 54%. In eight cases the intruded teeth were removed immediately, 86 teeth reerupted, and six teeth did not reerupt. Internal white enamel hypoplasia was seen frequently; external hypoplasia, seldom.


The occlusal fissure of unerupted third molars as an experimental caries model in man. The aim of the present investigation was to establish an experimental model for the study of fissure caries development under conditions as similar as possible to the in vivo situation. Twenty-one blocks (2 X 2 X 3 mm) constituting part of the occlusal fissure were made from unerupted human third molars, and implanted for 60 or 90 d in mandibular molars of students. One milliliter of a 50% sucrose solution was applied to the fissures twice a day. After removal, sections were examined microradiographically in polarized light and in the electron microscope. As a control, the morphology and enamel structure of fissures from 10 unerupted third molars were studied. After 90 d a subsurface, radiolucent caries-like lesion was observed in two specimens only. When examined in air in polarized light, however, all sections exhibited caries-like lesions symmetrically located around the fissures. The 60-d material showed similar lesions, but not as frequently as the 90-d specimens. In the experimental material processed for electron microscopy revealed that the fissure plaque mainly consisted of cocci and small rods. Most often the bacteria were separated from the enamel surface by a pellicle.


Size of nucleus and nucleolus in quantitative electron microscopy on orthokeratinized leukoplakias. Eleven leukoplakias of the homogeneous orthokeratotic type and control areas in the same patient were studied by means of standardized electron microscopic preparations of biopsy material and by methods of stereology applied to electron micrographs. In leukoplakias, nuclei and nucleoli were consistently enlarged at three epithelial levels, nucleoli in the basal cells averaging twice the control size. Comparison with specimens of mucosa of the hard palate showed that the enlargement of nuclei and nucleoli in orthokeratinized leukoplakias was in excess of the normal size differential between inherently orthokeratinized and nonkeratinized regions of the human oral mucosa. This suggests an abnormal stimulation of protein-synthetic activity even in this prognositcally "benign" type of leukoplakia.


Autoradiography of 99Mo in developing rat teeth and bone. Four littermate, 8-day-old rats were given intraperitoneal injections of 99Mo and sacrificed at 1, 4, 24, and 96 h. Autoradiography of whole-body freeze-dried sections was carried out to study distribution of the tracer, particularly in bones and teeth. The tracer was rapidly cleared from the soft tissues except for the kidney and urinary bladder. Uptake in growing bone was moderate and relatively transient. The dentin showed moderate uptake, but enamel in the final mineralization phase showed the most intense concentrations of 99Mo of all mineralized tissue. The tracer did not appear in the pulp, enamel organ, or early enamel matrix.


A new method of recording the elastic recovery of dental impression materials. Assessments of the elastic recovery of elastic impression materials have so far been carried out only to a limited degree because of lack of adequate measuring instruments. A method is described which enables measurement and recording electronically of the creep properties, including the elastic recovery time and the permanent deformation, of elastic impression materials in relation to their degree of setting and to the size and time of the induced deformation. The apparatus and the experimental and mathematical methods described can easily be handled by a reasonably skillful laboratory assistant.


Phases in preamalgamated silver amalgam alloy. The phase content of six preamalgamated alloys available on the dental market has been determined by means of X-ray diffraction. The beta 1-phase was found in five alloys.


Survival among patients with liver metastases from cancer of the colon and rectum. Factors influencing spontaneous survival in 49 patients with liver metastases after cancer in colon/rectum were evaluated. In addition the same evaluation was performed in 12 patients treated with 5-Fluoro-uracil systemically of intraarterially in the hepatic artery. Alkaline phosphatases, elevated more than 4 times normal values, elevated serum alanine aminotransferase, or jaundice are all unfavorable prognostic signs in the spontaneous group. In the 5-Fluoro-uracil treated group only elevated serum dilirubin had the same unfavorable prognostic sign. Even though it seems to be an increased survival time in the 5-Fluoro-uracil treated group it is concluded that metastases to the liver from cancer in colon/rectum assume to be more or less resistent to 5-Fluoro-uracil.


Postoperative mortality and complications after colectomy for ulcerative colitis. During a 10-year period colectomy was performed on 101 patients. The postoperative mortality of 12 per cent was influenced decisively by duration and severity of the disease. Seventy-eight per cent of the patients were severly ill during the attack leading to colectomy, and 15 per cent of them died. One-third of the patients with toxic megacolon and general intoxication died. One-quarter of the patients with a history of less than 3 months died. The causes of death were peritonitis and pulmonary complications. Half of the patients developed postoperative complications of varying severity. Preoperative steroid medication did not influence the mortality or the postoperative complications. It is concluded that only close medical and surgical cooperation, careful selection of patients, and skillful timing of operations may reduce the mortality in ulcerative colitis. The paper supports that total colectomy in suitable cases may be performed without higher mortality than subtotal colectomy.


Early complications in patients previously treated with corticosteroids. A retrospective analysis is presented is presented of 205 major operations performed over a 10-year period on 95 previously steroid-treated patients with Crohn's disease (C.D.) or ulcerative colitis (U.C.). All patients had been treated both in the medical and in the surgical gastroenterological department. The incidence of early postoperative complications was high, but there was nothing to suggest a relationship between the complications and the intensity of the preoperative steroid therapy. However, mortality rate, duration of hospital convalescence as well as incidence of complications were found to be significantly lower in those patients who had undergone elective in preference to emergency surgery. The fear of an increased complication rate following intensive steroid treatment of patients with acute C.D. or U.C. is, in our opinion, unfounded.


Penetration of penicillin into laparotomy wounds to reduce bacterial contamination during intestinal operations. Serum and tissue specimens from the surgical wound were taken simultaneously during colo-rectal operations (i) at the start, (ii) when entering the peritoneal cavity, (iii) during bowel procedures and (iv) before closure of the wound. A dose of 5 megaunits penicillin intravenously after incision gave a median serum concentration of 140.0 IU/ml and a tissue concentration of 33.8 IU/mg at the time the peritoneum was incised. During operation the concentration in serum fell significantly, being 18.5 IU/ml after more than 3 h of operation, while that in wound tissue decreased to 7.2 IU/mg. After concentration was 16.0 IU/ml in serum and 1.9 IU/mg in wound tissue at the time of incision and when entering the peritoneal cavity; thereafter the concentrations decreased with operation time. The concentrations in serum exceeded markedly those in wound tissue, being linearly correlated throughout operation. Only the intravenous bolus produced concentrations of penicillin antibacterial to a variety of aerobic organisms.


Route of infection in extrahepatic biliary tract disease. II: Bacterial recovery from gallbladder bile and gallbladder wall in human biliary tract disease. Bacterial recovery from gallbladder wall and gallbladder bile was investigated in 73 patients with extrahepatic biliary tract diseases. The technique of anaerobic culture was based on the use of a 'glove-box' and prereduced anaerobically sterilized media. Transport of samples was based on evacuation of atmospheric air with oxygen-free carbon dioxide and a transport time less than 30 minutes. When samples of bile and tissue were obtained simultaneously before operations on the biliary tract were begun and handled by one of the authors to avoid contamination, no significant difference in bacterial recovery between bile and tissue was observed. If samples were handled routinely by the staff or if biopsy from the gallbladder wall was not obtained until after operation on the biliary tract was finished, bacterial recovery from gallbladder tissue was significantly more frequent compared to bile. Under these last mentioned circumstances, the difference in bacterial recovery was due to bacterial species like Staph. aureus, Staph. albus, P. acnes and Difteroids.


Total devascularization of the Liver: an experimental model of acute liver failure. An experimental model of clinical liver failure, using total devascularization of the liver is described in the pit. The survival time was 1495 +/- 75 (SEM) minutes. Clinically the pigs showed a uniform course. They became lethargic after eight to ten hours and following a period of increasing drowsiness they became comatose. The immediate cause of death was cardio-vasculary collaps. The ammonium ion concentration in the blood increased to 696 +/- 57 umol/l and in cerebrospinal fluid to 664 +/- 57 umol/l. Cerebrospinal fluid glucose concentration was significantly decreased.


Total and partial anoxia of the liver. An attempt to create protracted liver failure in the pit. In an attempt to produce severe, but non-lethal experimental liver failure, pig livers were exposed to partial or total anoxia for various periods. The experiments were divided into 5 groups. Group I with total anoxia for 30 minutes, group II for 50 minutes, group III for 60 minutes, and group IV for 75 minutes. In group V a subtotal devascularization was performed. In group I (3 animals) and II (3 animals) all survived the period of observation (one week). In group III (4 animals) half of the animals, and in group IV (3 animals) all died within 24 hours. In group V (10 animals) five of 10 animals died with a mean survival time of 22 hours and a half. The animals surviving the period observation did show changes in the routine liver tests, but none of them showed clinical signs of liver insufficiency. This indicates that the differences between lethal and clinically insignificant liver damage is very small. It is concluded that the pig lever can tolerate 50 minutes of total anoxia and recover almost completely after one week, and that a period of anoxia or subtotal devascularization does not create protacted liver failure.


Serum-gastrin in cirrhosis.

Serum-gastrin in cirrhosis. Fifty patients with cirrhosis of the liver had gastrin concentrations in serum above normal when measured in the fasting state. Hypergastrinaemia predominated in non-alcoholic cirrhosis. In both groups of patients, serum gastrin levels were higher in patients with inactive cirrhosis than when cirrhosis was slightly active.


Disappearance of gastrin heptadecapeptide in the isolated perfused pig liver. To elucidate the role of the liver in gastrin metabolism three liver perfusions and two control experiments were performed; 2,5, 5 and 250 microgram of porcine nonsulphated gastrin-17 were injected into a perfusate of pig blood circulated through an isolated perfused liver. A significant decrease of gastrin concentration was observed during liver perfusions, concentration being halved in 35 minutes with all doses. It is suggested that this decrease is due to hepatic degradation and that the liver may play an important role in metabolism of gastrin-17.


Inhibition of gastric secretion by exogenous secretin and cholecystokinin in normals and duodenal ulcer patients. The inhibitory effect of combined secretin (0.5 and 1.0 clin. unit/kg b.w./hour) and cholecystokinin (0.5 and 1.0 IDU/kg b.w./hour on the pentagastrin-stimulated (0.15--1.0 and 6.0 ug/kg b.w./hour) gastric secretion was investigated in twelve volunteers and in twelve duodenal ulcer patients. Regardless of the dose level no difference was found between normals and duodenal ulcer patients, indicating that a decreased sensitivity to secretin and cholecystokinin is not a pathogenetic factor for the development of duodenal ulcer.


Combined effect of glucagon and cholecystokinin on gastric secretion in man. The inhibition of the pentagastrin-stimulated (1 ug/kg b.w./hour) gastric secretion by glucagon (20 ug/kg b.w./hour), cholecystokinin (0.5 IDU/kg b.w./hour), and a combination of these were investigated in 7 volunteers. Glucagon as well as CCK given isolated inhibited the gastric secretion, but no augmentation of inhibition was demonstrated when the hormones were in combination.


Influence of basal plasma glucose concentration on the glucagon response to arginine. Plasma glucose and glucagon concentrations were measured in the portal vein of six healthy, anaesthetized pigs submitted to an intravenous arginine infusion test. A monophasic glucagon response was observed in all pigs, the peak glucagon value being reached within an average of 5 minutes after the beginning of the infusion. The glucagon response, expressed as the incremental area below the hormone concentration curve, correlated inversely with the plasma glucose concentration before the start of arginine infusion (r=0.78) (p less than 0.05) indicating that glucose is a potent inhibitor of arginine-induced glucagon secretion in pigs.


Isolation and perfusion of the porcine pancreas. The isolation of a porcine pancreas preparation without the attached duodenum is described. The preparation is suitable for study of the secretion of insulin and pancreatic glucagon. The surgical procedure by which the pancreas is removed from tha animal is decribed as well as the perfusion system. The effect of various concentrations of glucose (63, 90, 135 and 180 mg per 100 ml) in the perfusion medium on the secretion of insulin and pancreatic glucagon was investigated in order to observe the performance characteristics of this preparation. Increasing concentrations of glucose caused a significantly greater insulin release, whereas the glucagon response was significantly reduced.


Insulin secretion in the Zollinger-Ellison syndrome. The insulin response to oral glucose ingestion was measured in six patients with the Zollinger-Ellison (ZE) syndrome, five patients with partial gastrectomy (antrectomy for duodenal ulcer) and six matched normal subjects. The blood glucose curves were similar in ZE-patients and gastrectomized controls and significantly above the glucose concentrations in normal controls. The insulin response was three-doubled in ZE-patients, whereas gastrectomized controls only doubled their response in comparison with the normal subjects. Treatment of a hepatic gastrinoma by streptozotocin infusion into the hepatic artery in a patient with diabetes mellitus and hyperinsulinism almost normalized his glucose tolerance and insulin secretion. The results demonstrate that the ZE-syndrome is associated with increased insulin release. We suggest that the hyperinsulinism partly is a consequence of previous gastric surgery and partly due to the insulinogenic effect of gastrin.


Principles in operative treatment of residual bile duct stones. Of sixty-five patients with residual bile duct stones 17 patients had a supraduodental choledochotomy as the only operative procedure. Of the remainder, 48 patients, a supplementary sphincteroplasty was carried out in 36, and a choledochoduodenostomy was added in 12 patients. Early postoperative results showed two deaths, while 40 patients passed an uneventful postoperative course. Following sphincteroplasty three patients had residual stones at the postoperative cholangiography. These calculi had disappeared at follow-up examination. Follow-up examination with a mean observation period of six years revealed 50 patients free of symptoms. Four patients were re-operated on because of residual stones. None of these had a sphincteroplasty. It is concluded that in the operative treatment of residual bile duct stones sphincteroplasty and choledochoduodenostomy offer valuable supplements to the supraduodenal choledochotomy.


Gastrin content and gastrin release. Studies on the antral content of gastrin and its release to serum during stimulation by food. To examine the release of gastrin by food from antral mucosa eight patients were stimulated for 30 minutes by instillation of bovril during gastroscopy. Bovril caused a steady increase in serum concentrations of gastrin and an acute fall in the antral content of gastrin to 42+/-8.4 per cent after 10 minutes. After 10 minutes the antral content increased again towards the basal values. No change in gastrin components could be detected; component III (gastrin-17) constituted more than 95 per cent of the antral gastrins throughout the 30-minute period. The serum gastrin response to a steak meal was higher in 22 duodenal ulcer patients than in nine young normal subjects and it was higher postoperatively in eight patients studied before and after truncal vagotomy. In the duodenal ulcer patients whith the highest antral content of gastrin, the serum response to food was higher only during the early phase of the feeding response. It is concluded that the gastrin content of the antral mucosa represents an acute releasable pool of gastrin-17, which contributes only to the first 10-15 minutes of the feeding response. It does not reflect the total amount of gastrin released into the circulation during feeding.


The vagus and gastrin components in peripheral blood. To study the role played by vagal activity for the gastrins in peripheral blood, the mean pattern during feeding was studied in 16 duodenal ulcer patients before and after selective (n=8), or truncal vagotomy (n=8). Two normal subjects were studied with and without atropine during hypoglycaemic activation of the vagus. Gastrins were fractionated by gel chromatography. Serum gastrin was almost exclusively made up of gastrin component II (gastrin 34-like) and III (gastrin 17-like). Both components rose after feeding but the major increase was incomponent III. Total gastrin concentrations rose after vagotomy but no qualitative changes were seen. During hypoglycaemia a marked increase in gastrin component III and a lesser increase in component II was found. This pattern was not changed by atropine. It is concluded that the vagus plays little or no role for a selective release of the various gastrins. Furthermore there is no indication that the higher serum levels after vagotomy consist of gastrins of a lesser biological activity.


On the beta-adrenergic contribution to the gastric acid and gastrin responses to hypoglycaemia in man. To study the beta-adrenergic contribution to the hypoglycaemic stimulation of gastric acid and gastrin release the effect of an equal and extensive beta-adrenergic blockade with three drugs was studied. Propranolol was investigated in 12, pindolol in 22, and practolol in 11 patients. Fasting concentration of gastrin serum and spontaneous acid secretion were not reduced by the drugs. Propranolol eliminated the gastrin response to hypoglycaemia, pindolol reduced it, and practolol caused no alteration. The hypoglycaemic acid response was reduced by all three drugs, propranolol reduced the response to one-half and was the strongest inhibitor, practolol the weakest. It is concluded that beta-adrenergic receptors may be of major importance for the hypoglycaemic stimulation of the stomach, but the receptors respond differently from the receptors in the heart.


Effect of epinephrine and norepinephrine on gastrin release and gastric secretion of acid in man. To study the physiological importance of epinephrine and norpinephrine for gastrin release and gastric secretion of acid the effect of intravenous infusions was investigated. Two doses were used (5 and 50 mg per kg per minute in one hour), the low dose of epinephrine and both doses of epinephrine (n=20) stimulated gastrin release and acid secretion, whereas the high dose (n=8) stimulated the gastrin release strongly, but did not change acid secretion. Norepinephrine in the low dose (n=11) caused a very small increase in gastrin release and no change in acid secretion, whereas the high dose (n=11) inhibited acid secretion without any change in gastrin concentration. No postoperative change was observed in the release of gastrin by both doses of epinephrine after truncal vagotomy in sex and seven patients with duodenal ulcer. It is concluded that epinephrine and norepinephrine both may be of importance in the physiological regulation of gastrin release and gastric acid secretion.


Gastrin response to food after three types of intestinal shunt operations for obesity. In a retrospective study the basal and food-stimulated serum concentrations of gastrin and gastric secretion of acid were studied in 28 patients following three types of intestinal shunt operation for obesity. In each type 48 cm of functioning small intestine was preserved, but the ratio between functioning jejunum and ileum was different. The basal and stimulated concentrations of gastrin in serum were significantly higher in patients with the shortest jejunum in function. There was no difference in the gastric acid output. The study suggests that gastrin participates in evoking the gastric hypersecretion of acid which follows massive bowel resection or bypass. Deprivation of a hormonal inhibitory substance from the upper jejunum may be responsible for the increased serum gastrin concentration.


Carcinoembryonic antigen (CEA). A prospective clinical trail in patients with gastrointestinal cancer. Tests for circulating carcinoembryonic antigen, CEA, in plasma were performed in 29 patients with colonic and rectal cancer, 37 patients with stomach cancer, and in 100 blood donors. Using 5.0 ng per ml as cut off, 48 per cent of the patients with colonic and rectal cancer and 32 per cent of the patients with stomach cancer had elevated CEA-values. The CEA-values could be correlated to the classification of tumours according to Dukes, with significantly elevated values in groups Dukes C and D. The test could reveal 39 per cent of the cases with operable colonic and rectal cancer and 26 per cent of the operable cases of stomach cancer. Five patients with colonic and rectal cancer, and 0 patients with stomach cancer fulfilled the requirements for monitoring. After periods of observation of up to 14 months, definite connection between CEA-values and clinical course could be demonstrated in 1/26 patients submitted to macroscopically radical operation. In 2/7 patients with stomach cancer the CEA-values were entirely misleading. It is concluded that the CEA-test in its present form cannot be recommended for routine employment in patients with gastrointestinal cancer.


The failure of granulocytes to produce transcobalamin I TC I. The hypothesis that transcobalamin I (TC I) originates from granulocytes was tested by comparing the isoelectric focusing (IEF) patterns of the R-type binder (cobalophilin) of vitamin B12 of: 1) lysed granulocytes, 2) 24 h granulocyte output, and 3) plasma. The preparations came from the blood of 5 normal subjects and 4 with myeloproliferative states. The cobalophilin released into a culture of granulocytes resembled the binder in the granulocytes initially. TC I, defined as the alpha1 cobalophilin with components isoelectric between pH 2.9-3.35 and as a carrier of native plasma B12, was not released by granulocytes. The granulocyte binder of leukaemic granulocytes did not differ from the normal in content per cell or amount released.


Added apparatus dead space in the N2-closing volume test: - a refinement or a bias. 14 subjects without symptoms of cardiopulmonary disease underwent paired closing volume determinations by the modified single breath nitrogen test. Measurements were performed with an apparatus dead space of approximately 40 ml and approximately 350 ml. A rise in closing volume percent for all subjects was found in measurements with dead space of 350 ml. This Difference was statistically significant at the 0.001 level for the group as a whole. No change in the accuracy of the method, expressed as the standard deviation of each subjects values with and without added dead space cojld be demonstrated. Linear regression analysis of the closing volume percent values measured with added dead space as a function of closing volume percent values measured without added dead space showed the expected highly significant positive correlation. However the regression line was not parallel to line of identity, indicating that the higher the initial value of closing volume percent the higher rise after addition of apparatus dead space. With reference to characterizing a person as normal or abnormal this could be considered a refinement of the method.


Epidemiological limitations of the nitrogen closing volume test. Closing volume was measured in 216 men aged 46-68 years. They were divided in 5 age groups and classified as either symptomatic or asymptomatic according to answer to standardized interviews. In 3 of 5 age groups mean value for closing volume percent (CV%) for symptomatic persons was lower than the mean value for asymptomatic persons. CV% is not considered useful as the dependent variable in a multiple regression analysis. In all 5 age groups the mean value of slope of alveolar plateau was higher for symptomatic than for asymptomatic persons. Slope af alveolar plateau is considered useful as dependent variable in a multiple regression analysis. One of the reasons for the false negative CV%-values is believed to be influence of increased uneven and sequential ventilation of the lungs, expressed in the slope of alveolar plateau.


Lung volumes and arterial blood gases in obesity. Lung volumes and arterial blood gases have been studied in six severely obese patients (mean weight 143 kg), admitted for jejunoileal shunt-operation. The lung volumes were recorded on a Siemens constant volume body plethysmograph, and the arterial blood gases were measured by means of a Radiometer ABL-1 blood gas analyzer. The patients were in the seated body position. The Functional Residual Capacity (FRC) was found to be 40% (mean value) of Total Lung Capacity (TLC). Predicted normal value of FRC/TLC% in non-obese subjects of the same height, sex and age is 54%. During tidal breathing the arterial oxygen tension (PaO2) was 84 mm Hg (mean value) compared to 95 mm Hg in non-obese subjects. A positive correlation between FRC/TLC% and the PaO2 was found. A series of 5 deep breaths normalized the PaO2 which rose by 18 mm Hg to 102 mm Hg (mean value). These results confirm the generally held opinion that the main abnormality of lung function in obesity is a reduction of lung volume to such a low value that airway closure occurs during tidal breathing, causing arterial hypoxemia.


Transfer of in vitro cytotoxicity against osteogenic sarcoma cells. Evidence of lymphocyte cytotoxicity against osteosarcoma, suggesting a degree of cell-mediated immunity, was found in the mother of a patient with osteogenic sarcoma. The mother was found to be HL-A identical to the patient and therefore was an ideal donor for whole lymphocytes. Lymphocytes were obtained from the mother by leukophoresis and were administered to the patient. Lymphocytotherapy transferred or re-established a delayed hypersensitivity response to mumps antigen and transferred the ability of killing osteogenic sarcoma cells in vitro. There was slight improvement in the patients' clinical condition coincident with the establishment of lymphocytoxicity in the patient. Loss of this capacity coincided with a rapid deterioration of the patient's condition.


Chromosome changes in patients treated with "Myleran". The aim of this study is the determination of chromosomal changes in patients suffering from chronic leucosis, after therapy with the cytostatic "Myleran", to find out whether this cytostatic causes them, because of clinical experience which indicates its value in the treatment of chronic myeloid leukemia. Patients were treated with therapeutic doses of 4 mg per os daily. Analysis with present methods in patients receiving relatively small total doses did not discover the other visible chromosomal aberrations in leucocytes in peripheral blood, except the usual aberrations caused by chronic leucosis.


Alacrima.

Alacrima. Alacrima, a congenital lack of tears, is a comparatively rare condition. Seven cases are presented, and the possible aetiology discussed. All cases should be followed up in view of the possible development of the full sicca syndrome later in life. Alacrima should be considered as an underlying condition in cases of red irritable eyes in young children, even in the absence of a definite history from the parents.


Immunoelectrophoretic analysis of subretinal fluid and its diagnostic significance. (1) Immunochemical examination shows that subretinal fluid can be divided into two major categories. A 'barrier pattern' is found in the presence of an effective blood-retinal barrier, whereas a 'barrier-damage pattern' emerges when there is a progressive increase in the permeability of the choriocapillarispigment epithelium complex. (2) The immunoelectrophoretic appearance of the subretinal fluid from a recent simple detachment shows a 'barrier pattern' and consists of only low molecular-size plasma proteins, since the choriocapillaris-pigment epithelium complex allows the smaller proteins to escape into the subretinal space more readily than the larger. There is, therefore, a general relationship between the clearance of any plasma protein in the subretinal space and its molecular size.(3) It is only in long-standing detachment that the permeability of the blood-retinal barrier is sufficiently altered to allow the passage of higher-molecular-weight proteins such as IgG and IgA. Increase in permeability of the choriocapillaris-pigment epithelium complex, due possibly to structural modifications, is responsible for the 'barrier-damage' pattern of the subretinal fluid. (4) There may be variations in the degree of barrier breakdown. In those retaining a highly selective barrier, little or no high-molecular-weight proteins escape in the subretinal fluid even in cases of long-standing detachment, whereas, in those with low selectivity, the leakage of high-molecular-weight proteins parallels that of the smaller proteins. (5) The apperance of very large molecules in the subretinal fluid indicates a preceding choroidal inflammation or neoplastic invasion; and the detection of IgM is, therefore, of value in the differential diagnosis of retinal detachment.


Ocular aspects of internal carotid stenosis. Because extracranial atheromatous disease of the carotid arterial system is a common cause of 'stroke', ophthalmologists may be the first to see patients at risk who present with early signs of this condition. I. The history of previous observations of these signs and the anatomy and physiology of the structures involved are described. The physical and subjective signs and the significance of transient ischaemic attacks are discussed. Methods of diagnosis are reviewed with special reference to ophthalmodynamometry. II. A series of patients personally investigated and treated is analysed: (1)Endarterectomy was performed in seventy cases of internal carotid artery stenosis during a 15-year period (1959-73). (2) 36 cases from the years 1970-73 were studied in detail. (3) 50 per cent. of these presented with ocular symptoms, which were the only complaint in 22 per cent. (4) 95 per cent. of all patients with ocular symptoms experienced recurrent transient visual loss. (5) 61 per cent. of all patients with ocular symptoms showed significant fundus changes. (6) ODM enabled the haemodynamics of the carotid arterial systems to be evaluated in 79 per cent. of the patients studied. (7) The results of surgery suggest that patients who present with ocular symptoms have a better prognosis than those who present with neurological symptoms only.


Drusen of the optic disc. A histopathological study. A retrospective study of autopsy and surgically enucleated eyes yielded eighteen autopsy and four surgically enucleated eyes harbouring drusen of the optic disc. The average age of the patients in this series was 58-6 years. Various histopathological changes were noted in the optic nerve head and adjacent retina; these comprised compression of nerve fibres, partial optic atrophy, elevation of the optic disc, cytoid bodies, disc haemorrhage, sequelae of haemorrhage, and juxtapapillary retinal scarring. All optic disc drusen were calcified and five of the ten disc drusen stained positively for the presence of iron.


Fundus changes immediately after cataract extraction. The effect of acute ocular hypotony as a factor in the formation of serous choridal detachments was investigated in 45 eyes undergoing cataract extraction. A fundus examination was made with binocular indirect ophthalmoscopy immediately after lens removal and in the early postoperative period. No choroidal detachments occurred, either early or late. Full-thickness infoldings of the eye wall in the posterior segment were seen in 80 per cent of the eyes immediately after lens extraction. The orientation of these folds is described, and factors leading to their formation are discussed.


Analysis of senile changes in the palpebral fissure. This work was carried out to determine the changes in conformity and physiological movements of the eyelids with advancing age. Some conceptions fostered in the literature are false and should be discarded. Others have been corroborated. We concluded that the whole lateral canthus becomes lax and drifts medially with age. Therefore, surgical correction should aim at restoring the fixation of the lateral canthus to the youthful position.


Pilocarpine delivery by hydrophilic lens in the management of acute glaucoma. Patients with acute closed-angle glaucoma were treated with a hydrophilic contact lens saturated in 1, 4, or 8 per cent. pilocarpine or bt intensive 4 per cent. pilocarpine drops. The greatest hypotensive response was produced by the 1 per cent. presoaked lens and increased strength of soaking solution gave reduced response. Intensive drops gave the least response. In vitro studies show that the lens is effectively saturated after 2 hrs' soaking holds c. 700 mug. pilocarpine and yields almost all of the contained pilocarpine after 2 hrs' elution. The method of lens preparation is described and pharmaceutical studies confirm a shelf life of 4 months in a domestic refrigerator.


New apparatus for measuring forces in strabismus. An apparatus for measuring muscle forces in strabismus has been developed. The globe is fixed with a modified suction cup, force applied is measured by strain gauges, and the excursion of the globe is measured by a light pointer and tangent screen. The values of force generation tests for normal horizontal rectus muscles performing 30 degrees saccades lie mainly within the range of 60 to 80 G.


Retinal opacification after blunt non-perforating concussional injuries to the globe. A clinical and retinal fluorescein angiographic study. Fluorescein angiographic studies are reported on fifteen patients presenting with retinal opacification after blunt mechanical non-perforating injuries involving the eye. In patients who subsequently regained full visual function and in whom complete resolution of the retinal changes occurred, retinal fluorography carried out less than 24 hours after injury revealed no abnormal features. In cases with more prolonged visual disability, retinal fluorescein examinations may, however, reveal damage to the retinal pigment epithelium before this becomes apparent  on routine ophthalmoscopy, or the existence of impaired perfusion through the retinal vessels. It is suggested, therefore, that retinal fluorescein angiography has a role in assessing the visual prognosis in patients presenting with traumatic retinal oedema.


Isolation of amoebae from eye infections in England. The laboratory investigations are presented on the first two recorded cases in England of infection of the eye by free-living amoebae. The distribution and pathogenicity of these amoebae are briefly discussed and some therapeutic possibilities derived from subsequent in vitro studies.


Filamentary keratitis.

Filamentary keratitis. Evidence is offered to support a hypothesis that filaments are composed of mucus with epithelial squames, lipid, and foreign matter taken up secondarily. The condition results when mucus excess is present with receptor sites on the cornea. Treatment should be directed at the receptor sites, the mucus excess, or the underlying conditions responsible for the two components.


Vascular pathophysiology of the ocular postural response. A pneumatonometric study. The technique of pneumatic tonometry has been used to study new aspects of the response of the intraocular pressure to change of body position. The pneumatonographic procedure permits the intraocular pressure to be recoorded independent of body position. A modification of the procedure is described for the measurement of the ophthalmic arterial pressure and for the analysis of the change in intraocular pulse with increased intraocular pressure. The magnitude and symmetry of the postural response in normal healthy individuals have been found to contrast with the magnitude, stability, and asymmetry of the postural response in patients with ocular and arterial occlusive diseases. The abnormality of the postural response in a patient with severe occlusive disease is shown to parallel asymmetric and low ophthalmic arterial pressures.


Visual loss due to posterior segment disease in scleritis. Exudative retinal detachment and oedema of the posterior retina are well-recognized clinical entities for which a cause is rarely found. Scleritis may cause both these clinical syndromes by a spread of inflammation from the sclera into the uveal tract. Although treatment may result in a rapid resolution of scleritis, retinal detachment and macular oedema persist and prove extremely resistant, even to high doses of systemic steroids. Recovery may be incomplete and may occur only after weeks or months of treatment.


Electrodiagnosis and ultrasonography in the assessment of recent major trauma. This paper reports a prospective study of 47 eyes with opaque media after recent major ocular trauma which were assessed by measurement of visual acuity, electroretinography, visually evoked response, and ultrasonography. The results of each method of assessment were analysed as indiced of prognosis for visual recovery. Each method of examination proved of value for prognosis, and a combined assessment using all the methods together was of special value.


Multicentre trial of xenon-arc photocoagulation in the treatment of diabetic retinopathy. A Randomized controlled study. Interim report. An interim analysis of the cases in the British Multicentre Photocoagulation Trial shows that treated eyes with maculopathy retain better visual acuity than untreated eyes. The difference of the change in the mean visual acuities of the treated and untreated eyes is small but statistically significant. In those with new vessels as the predominant feature, there is a trend for treated eyes to have better visual acuity than untreated eyes, but the difference in the mean visual acuity of the two groups is not statistically significant.


[Blast leukosis in adults].

[Blast leukosis in adults]. The clinic, paraclinic, treatment and course as well as the outcome of blast leukosis in elderly people is followed up. In all of the 17 patients with blast leukosis, the disease initialed under the mask of another disease: hematuria, angina pectoris gravis, myocardial infarction, jaundice, gastroenterocolitis, etc. The course is serious and in spite of the treatment all patients have a lethal end within 2-3 months.


[The effect of hypovolaemic shock on the pancreas (author's transl)]. Morphological changes similar to those found in acute pancreatitis were found at autopsy of ten patients who had died following temporary hypovolaemic shock. In an experimental study it was demonstrated by means of electromagnetic flow measurements that hypovolaemic shock results in a significant decrease in pancreatic flow, which is paralleled by a significant decrease in oxygen consumption of the organ in spite of a compensatory increase in the arterio-venous oxyhaemoglobin difference. These haemodynamic changes are followed by hypoxic cell damage mainly in the periphereal areas of the pancreatic acini, with resultant necrosis, as found in acute pancreatitis.


[Analysis of the progressive phases of diabetic retinopathy. Prevention and treatment by photocoagulation (author's transl)]. An attempt has been made to clarify various unresolved problems concerning the pathogenesis, course and treatment of diabetic retinopathy (d.r.) on the basis of an analysis of 2320 fluorescein angiograms performed on 150 patients at intervals of 1 week to 6 months during the period January 1967 to April 1975. The characteristic changes of diabetic angiopathy are already visible in the angiogram before the ophthalmoscopic and biomicroscopic features of d.r. become manifest (preretinopathic stage). Like in the later stages of d.r., hyperpermeability of the retinal capillaries predominates in certain patients, whilst stenosis and obstruction of the precapillaries and arterioles prevail in the remaining patients. Hyperpermeability frequently causes a decrease in, or a failure of perfusion of the retinal capillaries due to compression by the swollen perivascular tissue. D.r. is characterised by phasic development. In cases of primary exudative angiopathy an increase in the capillary hyperpermeability can precede phases of progression. Cases of primary occlusive angiopathy display a jerky type of involvement of larger and larger retinal vessels. An additional exudative component accelerates progression of the angiopathy. Large zones without visible capillaries or multiple small areas with deficient capillarisation, IRMAs and shunt vessels herald the imminent onset of the proliferative stage (preproliferative stage). The primary exudative types show slow evolution, whilst the primary occlusive types show rapid, phasic progression...


[Functional replacement of the left heart with an intrathoracally implantable ventricular-aortic blood pump (author's transl)]. An implantable ventricular-aortic blood pump was employed for the functional replacement of the left heart. Pilot studies were performed in 12 dogs to test new materials and manufacturing innovations used in the production of the blood pumps. Further pilot studies were undertaken to evaluate prophylactic measures against infection along percutaneous driving lines. A skin button made from biomaterials and covered with antibiotics was subcutaneously implanted in 2 dogs and 5 calves. No infection was seen along the percutaneous lines for up to 6 months later. After the implantation technique had been worked out in 15 calves acute haemodynamic studies were undertaken. The implanted pump took over, on average, 88% of the cardiac output. The peak systolic ventricular pressure was decreased from 106 to 18 mm Hg. The myocardial oxygen consumption was thereby decreased by 21% in respect to the control value. A ventricular-aortic blood pump was implanted in 12 calves for long-term studies. The longest duration of pump experimentation was 73 days. The laboratory examinations show that all body functions return to normal within 10 days and that the pumping device is completely integrated into the living organism.


[A clinical-immunological concept of sarcoidosis]. A survey on immunologic phenomens up to now known in sarcoidosis is given and completed by own investigations in sarcoidosis patients concerning passive transfer of tuberculin reactivity, sensitivation with chemical contact allergens, lymphocyte transfer reaction, lymphocyte cultures, macrophage reaction in skin window, immune globulins, Kveim's reaction and reaction of basophilic granulocytes. As result of the investigations an immunologic conception of sarcoidosis is put up for discussion. The diminishment of the delayed type reactivity is the consequence of a strengthened immediate reaction on the begin of the disease. Therefore the impairment of T-lymphocytes would be not the cause but the consequence of the disease. Hypothetically a blockade of the surface of T-lymphocytes by products of the immediate reaction, for example immune complexes, is suggested. In this way it would be easier for the clinician to image, why sarcoidosis occurs in persons showing otherwise signs of hyperreactivity. The clinic of sarcoidosis is impressed by this hyperreactivity, especially by overwhelming formation of granulomatous tissue.


[The lymph node perforation in tuberculosis and its consequences for the course of pulmonary tuberculosis]. After a historic review of the ever changing views concerning the pathogenesis of tuberculosis, a special possibility of extension is closely examined, that is the lymph node perforation into the bronchial system. In the past decades, the importance of this has been commensurately over --  as well as under -- evaluated. Our own examinations are based upon the experience gained by over 20.000 bronchoscopies in the past 25 years. According to the formulations of these examinations, carried out in 3 different groups, the following correlations were determined: The first series, registered during the years 1949-1952, included tuberculosis patients alone. In these series, 5.5% of the bronchoscopically proven changes were of tubercular lymph node perforation. The second series, published in 1961, included the compiling of 350 bronchoscopies performed on 350 cases of tuberculosis in the old age. In these series 11.4% of apparent lymph node perforations were observed. The third series contained 6021 bronchoscopies which were performed during 1970-1975. In this series, the tuberculosis presents only a small percentage of pulmonary diseases. In these cases, 2,9% were revealed as florid or healed lymph node invasions. This percentage would indicate that in cases of tuberculosis, lymph node invasion into the bronchial system means a minimal incidence. However, these figures, which are only based upon bronchoscopically determined findings must be considered, from an anatomical point of view, as the lowest occurrence border. Upon the basis of individual cases, different clinical pictures have been described, whereby these lymph node perforations can be clinically manifested. Consequently, it is this obturation with symptomatic foreign bodies, the atelectasis, which can falsely be diagnosed as a malignant bronchial closure, and also spread and aspiration even as is observed in the pneumonias. Additionally, because of interlobular lymphogenic propagation a similar symptom may be produced. Finally, as a last significant clinical manifestation, bleeding must be mentioned. Such bleeding is caused primarily when a caseous lymph node simultaneously perforates into the bronchial system and into a neighboring blood vessel. Over the past 25 years the clear up of the findings, due to constant improvements in bronchoscopy, have culminated in a method, the importance of which must be necessarily emphasized. This method should be universally utilized as routine examination in pulmonary departments and its neglecting should only be justified in specifically indicated cases.


[Immature-cell leukosis as a chance finding]. It is reported on a 35-year-old man in whom by chance was made the diagnosis of an undifferentiated cell leucosis during a routine investigation of the blood before an haemorrhoidectomy. In a number of leucozytes of 234.000/mul 96% of paraleucoblasts were found. Haemoglobin and thrombozytes were normal. Cytochemically a lymphoblast leucosis was concerned. By means of a cytostatic combination therapy (ViDaP-scheme) the clinically latent leucosis was brought into a very good partial remission. A recidivation appearing five month later led in form of a haemorrhagic diathesis to the first symptoms recognizable for the patient.


Cells from the seminal vesicles: contaminants of the V-C-E smear. Cells originating in the seminal vesicles are occasionally observed on routing gynecologic smears. Sometimes, these cells may display large hyperchromatic dense nuclei, which conceivably may produce diagnostic problems. The identification of these cells is therefore of practical significance in order to avoid one more pitfall in gynecologic cytodiagnosis.


Histopathologic criterion of dysplasia of the uterine cervix and its biological nature. A histopathologic diagnostic standard for abnormal epithelium of the uterine cervix, based on its biological behavior, has been proposed, and dysplasia and carcinoma in situ have been classified according to this standard. Benign dysplasia by this classification may be considered as a benign lesion, and only the lesion which satisfies the standard for atypical dysplasia should be considered as dysplasia, having a significance as a precursor to cervical cancer. This would be clinically convenient.


Cytohormonal and histomorphologic patterns in endometrium in symptomatic premenopausal women. Endometrial histology in the premenopausal symptomatic group revealed hyperplastic endometrium in 29.1 percent of the cases. Cytohormonal evaluation has shown hyperesterin activity reflected by a high Karyopyknotic Index in cystic glandular and adenomatous hyperplasia. A fairly good positive correlation is seen between colpocytology and endometrial histology. In few patients vaginal cytology has revealed regressive activity which was not evident on histology alone. It is felt that cases showing regressive smears are the ones where treatment including estrogens should be most effective.


Reliability of cytologic typing of lung cancer. In a prospective study of 111 cases of lung cancer, cytopathologic diagnoses were compared with histologic diagnoses. In 77.5 per cent of the cases, histopathologic diagnoses were in concurrence with cytopathologic diagnoses. The discrepancies occurred mainly in poorly differentiated adeno and  epidermoid carcinoma. Well differentiated adeno and epidermoid carcinoma were cell typed with 100 per cent accuracy and small cell carcinoma with 90 per cent accuracy.


[Simultaneous determination of gastric emptying and bile and pancreatic enzyme secretion]. Intestinal perfusion methods with a nonabsorbable marker allow an exact quantitative determination of intestinal absorption and secretion provided that methodological pitfalls are avoided. A modified technique is applied to the simultaneous measurement of biliary and pancreatic secretion during and depending on emptying of a mixed test meal. A duodenal segment was perfused with an isotonic polyethyleneglycol solution (PEG). Reinjection of duodenal aspirates maintained a normal enterohepatic circulation of bile acids (interruption less than 10%). The perfusion was performed in healthy volonteers over a period of 12 to 24 hours, with three mixed formula meals containing 51CrCl3 as a marker ingested at conventional feeding hours. Influence of meal size was studied by means of a high caloric (40 Kcal/b. wt. per day) test meal. Patients with cholesterol gallstones and cirrhosis of the liver only received one formula test meal of 300 Kcal. Instead of concentrations output of trypsin, lipase, bile acids and cholesterol (the latter corrected for duodenal absorption) was calculated from the dilution of PEG in the duodenal juice and gastric emptying was determined by following quantitatively the flow of 51CrCl3. Gastric emptying can be expressed by a single exponential function over most of the time. Only the last 60-100 Kcals were expelled by the stomach at a faster rate. The daily biliary and pancreatic secretion depend indirectly on the amount of food ingested. But during the day light hours (with continuous meal flow), secretion was similar in high and low caloric subjects, while a significant difference became obvious during night hours corresponding to differences in gastric emptying time. Mean hourly output of bile acid, biliary cholesterol, trypsin and lipase is independent from meal size and secretion of pancreatic enzymes reaches the values close to those after maximal stimulation by i.v. CCK-PZ. Output of pancreatic enzymes does not differ in health and gallstone disease or cirrhosis of the liver respectively. Since during digestion in normals approximately one forth of the bile acid pool is secreted hourly into the gut, the number of daily enterohepatic cycles of bile acids can be calculated by 4-6. Patients with cholesterol gallstones maintain normal bile acid output by enhanced cycling of the small pool: An average of 50% of the pool passed the duodenum per hour. A decreased bile acid pool is also present in cases of advanced cirrhosis of the liver. However, hourly output of bile acids in these patients is significantly less than in mild cirrhosis (with normal bile acid pool) or normal controls. Therefore the hourly fraction of the pool secreted is similar to healthy subjects. These findings provide an important information to explain abnormalities in bile acid metabolism in cirrhosis.


[Aspects of bile acid metabolism in liver diseases(author's transl)]. Although chemistry and physiology of bile acids have been elucidated during the last two decades, tests concerning bile acid metabolism are still rarely used in clinical medicine. The aim of this study therefore was, to investigate bile acid metabolism in patients with liver diseases and to find prognostic valuable parameters which can be recommended for clinical use. Following an introducing review of biosynthesis and kinetics of bile acids, normal values are presented for pool size and synthesis of the two primary bile acids, for bile lipid composition, plasma bile acid concentration and for clearance and conjugation of intravenously injected 14C-cholic acid, which have been measured in healthy subjects. Bile acids were determined by thin-layer-chromatography, gas-liquid-chromatography and by an enzymatic and fluorimetric method. In all patients investigated with acute hepatic necrosis, plasma disappearance of radioactivity was greatly prolonged after intravenous injection of 14C-cholic acid. By estimating free 14C-cholic acid and 14C-cholic acid conjugates in plasma individually, two groups of patients could be distinguished: in patients who survived hepatic coma, the clearance of free 14C-cholic acid was significantly more rapid and the percentage of glycine and taurine conjugates of 14C-cholic acid in plasma was significantly higher than in patients who died in coma. This prognostic significant differentiation was possible by measuring the relationship of conjugated: unconjugated radioactivity in one single plasma sample taken three hours after injection. In patients with cirrhosis of the liver the plasma disappearance rate of radioactivity during 60 minutes following injection of 14C-cholic acid was significantly correlated with serum-bilirubin, SGOT, serum-albumin, prothrombine-time, plasma bile acids, and a clinical scoring. 14C-deoxycholic acid was found in plasma of only a few patients 24 hours after injection of the labelled cholic acid, and was related to the relatively good liver function in these patients. It is concluded that the following tests of bile acid metabolism are of clinical interest: 1. Measuring plasma bile acid concentration may serve as a sensitive liver function test. 2. Estimation of the conjugation of intravenously injected 14C-cholic acid is of prognostic value in patients with fulminant hepatic failure. 3. Determination of the initial plasma disappearance rate of 14C-cholic acid injected intravenously and its transformation to 14C-cholic acid injected intravenously and its transformation to 14C-deoxycholic acid may help to classify patients with cirrhosis of the liver.


Fine needle aspiration biopsy in the evaluation of tumor-like lesions of bone. A consecutive series of bone lesions suspected to be tumors and examined by fine needle aspiration biopsy at the University Hospital Cytology Laboratory in Lund, Sweden, is reported. From 1966 to November 1974, 150 cases were examined. In 123, sufficient cellular material was obtained through aspiration by a needle with an outer diameter of 0.8 mm. The method is described. The reliability of cytology is compared with the results of the definite pathology after open biopsy or extirpation of the lesion. In the series of primary benign lesions 28 out of 39 were correctly diagnosed; among primary malignant 27 out of 38 were correct and among metastases 57 out of 73 were correctly diagnosed including those  where insufficient cellular material was aspirated. In cases where sufficient material was achieved the reliability of the cytological diagnosis was around 90 per cent. There was one false positive and two false negative reports of malignancy. Fine needle aspiration biopsy with cytology is recommended as a standard step in orthopedic oncological examinations. It has at least the same degree of diagnostic reliability as other diagnostic methods, such as X-ray, for instance; however, it does not replace open biopsy and histology when mutilating surgery is in question.


The fine structure of exfoliated cervical and vaginal cells. In order to understand the means by which cellular aggregates were maintained in gynecologic samples, the fine structure of samples derived from a number of women of various ages was examined with special attention paid to the intercellular junctions. Most cells in the samples were squamous cells containing numerous intercellular fibrils and glycogen granules. Parabasal or intermediate cells were also seen as well as occasional endocervical cells. All of these cell types were often found as parts of aggregates and, while other cell junctions were present, desmosomes were the most prominent. It was concluded that desmosomes were probably responsible for maintaining the aggregated state of many of the cells found in gynecologic samples.


Influence of blood collection on incidence of 2,7-FAA induced rat leukemia. The oral administration of N, N'-2,7-fluorenylenebisacetamide induced leukemia, especially mature granulocytic leukemia, in rats. The peripheral blood was examined on various schedules, once or twice a week for a long term. The blood volume lost by a blood collection was little, but it was not negligible in small animals such as rats when the loss was repeated. We investigated the relationship between the volume of blood loss and the incidence of leukemia. The incidence of leukemia rose as the volume of blood loss increased. There was a positive correlation between them. The induction of mature granulocytic leukemia was thought to be increased by the promotion of the granulopoiesis which had been suppressed by 2,7-FAA. It was concluded that the blood loss by repeated blood collection for examination raised the incidence of 2,7-FAA induced leukemia.


Fifty-three month persistence of ring chromosome in noninvasive bladder carcinoma. In a recurrent noninvasive papillary carcinoma of the bladder cytogenetic analysis by the direct technique was carried out on cystoscopic biopsies obtained at 53 month intervals. Persistent similar karyotypic abnormalities including aneuploidy, and ring and other marker chromosomes, the hallmarks of invasive cancer, were present in both specimens. In the 1973 specimen, DNA banding was identified in 35 per cent of the metaphases and in 56 per cent of the karyotypes. The continuing abnormal chromosomal silhouette of this tumor supports the stemline cell concept for malignancies, even when applied to such relatively benign neoplasms as this noninvasive carcinoma of the bladder.


Acute myeloid leukemia appearing in two patients after prolonged continuous chlorambucil treatment for Wegener's granulomatosis. Two patients with Wegener's granulomatosis have been treated with chlorambucil and prednisolone continuosly for 3 and 5 years, respectively. This treatment was effective in controlling the disease, but bone marrow toxicity with severe pancytopenia developed in both cases. Both patients died from thrombocytopenia with haemorrhagic pericarditis. In one case, the diagnosis of acute myeloid leukaemia was established from the appearance of myeloblasts in the peripheral blood and from characteristic bone marrow morphology. In the other case this diagnosis was strongly suspected on the basis of the bone marrow morphology alone. It is proposed that this development of acute leukaemia in two patients with a primary non-neoplastic disease may result from a direct carcinogenic action of chlorambucil in humans.


Nutritional aspects of high-altitude exposure in women. The nutrient intake and urinary excretion characteristics of eight young university women were studied over a 4-day period at low altitude (140 m) and subsequently over a 7-day sojourn on Pikes Peak (4,300 m). High-altitude exposure was associated with a transient decrease in the consumption of protein, carbohydrate, fat, sodium, calcium, phosphorus, vitamin A, riboflavin, thiamin, and niacin and a more sustained decrease in the consumption of potassium and ascorbic acid. In most instances minimal values were observed during the first 3 days of exposure. The carbohydrate fraction of energy intake was increased at the expense of fat during this time period. Individual hypophagic responses appeared to be related to severity of acute mountain sickness. Altitude had no effect on water consumption but did lead to an average body weight loss of 1 kg. Urinary measurements revealed a marked oliguria during the entire sojourn. These measurements also showed the first 3 days to be associated with a net loss of body nitrogen and sodium. During this time period body potassium and phosphorus were conserved, and probably increased. The urea fraction of body potassium and phosphorus were conserved, and probably increased. The urea fraction of total urinary nitrogen was not affected by altitude exposure, nor was the daily excretion of uric acid and creatinine. Ammonia excretion, however, was reduced to 50% of the low-altitude value and remained at this level throughout the sojourn. With a few exceptions, the qualitative characteristics of altitude hypophagia in women were similar to those reported for men. Quantitatively, however, the responses were much more transient in women.


Critical evaluation of the ANB angle.

Critical evaluation of the ANB angle. It has been demonstrated, first, in an empirical manner (qualitatively) and, second, in a geometric-mathematical manner (quantitatively) that the ANB angle depends not only on the anteroposterior relationship of the jawbones (which it should measure) but also on the maxillary inclination and maxillary prognathism, and slightly on the facial dimensions. Faces having the same anteroposterior value for the jawbones can have very different ANB angles (Figs. 3 and 4) and vice versa.


Open-bite relapse. Report of a case.

Open-bite relapse. Report of a case. Although the tooth positioner was initially helpful in promoting improved esthetics and stability, it in effect became an orthodontic appliance by maintaining the original, treated occlusal plane. Subsequently, the lower third molars erupted above the occlusal plane and caused the mandible to rotate downward and backward, resulting in an unsightly bite opening. Removal of the etiologic factors, the tooth positioner, and third molars corrected the open-bite relapse.


A handicapping malocclusion assessment study at West Virginia University. 1. The AAO Handicapping Malocclusion Assessment Record (HMAR) was tabulated using 100 before-treatment records and dental casts of patients presenting with permanent dentition. 2. The 100-patient sample exhibited scores ranging from 52 points to 11 points. A cut-off point was established at 30 points. This divided the sample into two groups of fifty patients each. This hypothetic situation accepted for treatment those with the fifty highest scores and did not accept those fifty with the lowest scores. 3. The accepted group had 70 per cent skeletal malrelationships (Class II and Class III), while the nonaccepted group presented with 32 per cent skeletal discrepancies. 4. Maxillary incisor interarch deviations were found in 48 per cent of the accepted group but in only 12 per cent of the group not accepted. 5. Mandibular incisor interarch deviation (overbite) occurred in 6 per cent of the nonaccepted group and in 54 per cent of the accepted group of patients. 6. Four patients who required rapid palatal expansion and one who had undergone a mandibular resection were in the nonaccepted group. It was shown that if these patients were examined clinically using the Supplementary Oral Assessment Record, 19 their dentofacial deviations would merit 16 additional points and all five would be promoted to the accepted group.


Orientation-sella-nasion or Frankfort horizontal. The controversy regarding the most appropriate line for cephalometric orientation has been resolved and can be summarized in the following five areas of consideration: 1. Clinical significance. The ability of the clinician to visualize the Frankfort horizontal plane affords him the opportunity for effective clinical communication, which is lacking with sella-nasion. In addition, he is able to demonstrate the orientation of the face, chin, and palate to Frankfort horizontal plane, which is also lacking in the sella-nasion system. 2. Anatomical significance. The direct relationship of the Frankfort horizontal plane with the basic sense organs of sight and hearing displays a relationship to the face. Sella, in contrast, relates to the brain and not the face. 3. Measurement accuracy. Studies performed to test the accuracy of selection of the planes under consideration showed no significant differences when true porion and not the ear rod was used and when experienced technicians performed the tracings. 4. Application in description. If the reference line is to be considered reliable for description, the correlation between the measurements of the maxilla and the mandible to the reference line should be minimal. In a study performed, SNA and SNB displayed a significantly higher correlation than N-Po to FH and N-A to FH. 5. Application in growth forecasting. A study was performed in order to evaluate the application of these lines of orientation to growth forecasting. In every instance the reference frame which utilized the Frankfort horizontal plane was appreciably better than that which utilized sella-nasion.


The use of the occlusogram in planning orthodontic treatment. A method of planning orthodontic treatment in the transverse plane has been presented. The occlusogram procedure outlined augments other orthodontic records in order to define more specifically the requirements of successful orthodontic treatment. Anchorage requirements, extractions, if any, and arch widths plus the final occlusal relationships can be determined at the outset of orthodontic treatment.


The relationship between lower incisor inclination and various reference lines. The relationship between the inclination of the lower incisors and different cranial reference lines has been studied in a group of 60 children including 35 males and 25 females between the ages of 7-12 years. Following a 3-4 year observation period, 30 of these children were reexamined to study the relationship between changes in the position of the lower incisors and various craniofacial variables brought about by growth. In analysing the results obtained, an attempt was made to distinguish between those relationships which were to a certain extent due to a topographical relationship between the variables involved and those relationships which were of a biological character. The results obtained from the first registration indicated a strong correlation between Ll-NB mm and Ll-ML degrees and Ll-NB degrees. In addition, the connection between lower incisor inclination and the basal bone relationship (ANB degrees) was found to be strongly significant. The angle ML/NL was found to be correlated only with the inclination of the lower incisors to the mandibular line. Regarding the growth changes occurring during the observation period, no significant correlation could be found between, on the one hand, changes in lower incisor orientation and, on the other hand, changes in the angle ML/NL. The absence of this relationship has been interpreted as being due to the influence of environmental factors in the form of tongue and lip function.


The application of quantitative perioral assessment to orthodontic case analysis and treatment planning. Maximum tonicity of the lips can be accurately measured through the use of the pommeter. 2. Patients with significant hypertonicity of the lips whose maxillary central incisors are positioned oingualy as in Class II, Div. 2 and also in certain Class I malocclusions should be treated nonextraction and as early as possible. Torguing maxillary incisors into a more normal labial axial inclination is a form of expansion which does not detrimentally affect the position and function of the perioral muscles. In this early conservative approach not only is arch length increased but also marked improvement in the overbite is accomplished. These types of treated malocclusions should be retained until after the eruption of the second permanent molars. 3. If extraction is necessary in patients with hypertonic lip muscles it should be done as far as possible from the incisor teeth, preferably the second premolars. 4. In Class I malocclusions where maximum tonicity is in the normal range is to attempt to accommodate blocked out or rotated teeth within the framework of the perioral musculature surrounding the teeth...


Posttreatment and postretention changes following orthodontic therapy. This investigation was performed to determine the changes which occurred in treated orthodontic cases out of retention. The material consisted of 103 cases, of which 74 cases were treated nonextraction and 29 were treated with the extraction of four first premolars. The treatment was accomplished by the full-banded edgewise bioprogressive technique. Five measurements were taken: intercanine, inter-first premolar, intersecond premolar and inter-first molar widths, and incisor to molar distance. The measurements were made on the mandibular arch of the pretreatment, posttreatment, and prostretention casts. The postretention model was obtained a minimum of one year after all retaining devices were removed with an average of 5.2 years. The following conclusions were drawn from the changes in dimensions: 1. The intercanine width was expanded during treatment, but had a strong tendency to return to or close to its original pretreatment width in both nonextraction and extraction cases. 2. The inter-first premolar width showed the greatest treatment increase in width with only a minimal amount of postretention decrease. 3. The second premolar width for nonextraction cases showed a significant amount of increase with a slight tendency for postretention decrease. 4. The second premolar width for extraction cases showed a decrease with treatment and a slight continued decrease postretention. 5. The intermolar width of nonextraction cases showed a significant increase in width with treatment. The extraction cases showed a significant decrease with treatment. However, there were no changes in either extraction or nonextraction cases postretention. 6. The incisor to molar distance decreased with treatment and had a slight tendency to continue to decrease postretention.


Orthodontic treatment of malocclusions caused by facial trauma. Assessment and orthodontic treatment of malocclusions caused by traffic accidents were reported. Different methods were employed to reestablish the harmony of the occlusion with consequent good facial appearance. Appliances like the activator and direct bonding techniques were illustrated. Principles and techniques of orthodontics play an important role in the treatment of the malocclusions left untreated at the time of surgical operation for the facial trauma.