[A standard projection for temporomandibular joint radiographs in oblique lateral projection]. A standard projection for temporomandibular joint radiographs in oblique lateral transcranial projection was determined by a clinical method. The individualized projections from 1644 TMJ radiographs, made with a fluoroscopic examination unit with image intensifier, were evaluated in a pilot study. A mean projection 20 degree cranial eccentric and 12 degree dorsal eccentric resulted. Reference planes were the Camper plane and the middle frontal plane. This projection, corrected in 22 degree/10 degree, was studied in a clinical study in order to test the readability of the radiographs of 100 temporomandibular joints. The readability of these radiographs was compared with that of radiographs obtained with an individualized projection. 81 radiographs out of 100 were well or very well readable, 7 were limitedly readable and 12 were unreadable. The number of radiographs in these last two categories could not be reduced by an individual angulation of the x-ray beam. Therefore anatomical reasons have to be considered to be responsible for the insufficient readability of these TMJ radiographs. This projection avoided superposition of the petrous portion of the temporal bone without giving an extreme view of the lateral slope of the condyle. From the evaluation of the 100 individualized projections resulted a mean projection 21 degree/10 degrees, which confirmed the projection 22 degrees/10 degrees used in this study. The projection 21-22 degrees/10 degrees turned out to be a most favourable projection for the dental office to make TMJ radiographs in connection with the diagnosis of the occlusion in patients with TMJ disorders.


[Long-term experiences with marsupialization of large mandibular cysts into the oral vestibulum]. After a few remarks on the indication for marsupialisation and the choice of therapy, the treatment of large mandibular cysts as practised in the Zurich Clinic is described. 53 cases were all marsupialized into the oral vestibulum. Postoperative healing was without complications in 49 cases, while 3 cases showed delayed healing and in one case, an undislocated fracture occurred from trauma. Postoperative treatment with a vaselinated iodoform gauze lasted between 3 and 5 weeks. Postoperative discomfort was described as mild by the patients. Bone regeneration was good, as shown by late controls of 48 surgically treated cysts: 42% did not show any dip in the bone, in 54% a slight dip, unnoticeable by the patient remained and only in 4% cases the recess disturbed as a food trap. These encouraging results have established marsupialisation as a most useful method, preferable to cystectomy because of the absence of complications and of the necessity of bone transplantation. The method should be limited however to the horizontal ramus. Extensive cysts of the ascending ramus are operated by another method.


[Economic aspects of organized and supervised oral hygiene drives]. The caries reduction of 1.8 tooth surfaces (32,1%) after 5 years of an oral hygiene action using amine fluoride corresponds to a reduction in working time of 0.62 hours; or, on a working time per child basis, to 2.89 hours. The cost of one local application is 0.60 M; 21.60 M must be spent per annum and child. Expressed in terms of working hours, this corresponds to 11.76 M per hour, which is very low in comparison with figures from other countries. It is shown that oral hygiene actions using amine fluoride, supervised by a dental nurse, are collective measures that are economically justifiable.


[Clinical and radiological studies on the distribution of caries on the various milk molar surfaces in children aged 1-7 years]. The present paper deals with the results of clinical and radiographic examinations of 1996 children from nurseries and nursery schools, performed for the purpose of disclosing the caries experience of the deciduous molars and of their surfaces (subdivided into occlusal, mesial and distal surfaces) with regard to age. In the children from nurseries, caries was mainly experienced by the occlusal surfaces. In the children from nursery schools, caries occurred both occlusally and proximally. As to the first deciduous molars, caries was experienced more often distally (35.9%) than mesially (11.7%). The reverse held true for the second deciduous molars (distally, 7.0%; mesially, 31.7%).


[The most frequent mistakes in intraoral radiography]. The authors analysed 2000 intra-oral radiographs that had been taken, using the bisecting technique according to the isometry rule of Cieszynski/Dieck, at an institution being typical of the ambulatory public health service during a period of 5 months. 602 (30.1%) faulty radiographs were detected. The classification of the faulty radiographs showed that 395 (65.6%) were caused by errors in projection; 116 (19.3%), by errors in the dark-room; 59 (9.8%), by errors in exposure; and 32 (5.3%), by defective equipment. Defects in the film material used in the present study were not observed. The relatively high rate of faults calls for improvements of the programs for the education and the advanced training of stomatologists and stomatological nurses, and for improvement of the radiographic technique.


[Radiographic findings in clinically edentulous sections of alveolar processes]. In the absence of symptoms indicative of pathological processes in the region of clinically edentulous alveolar processes, primary radiographic examination is sometimes omitted. For this reason, the authors report the results from the evaluation of the radiographs of 2177 patients with clinically edentulous alveolar processes. 320 (14.7%) positive findings were obtained from 278 patients. The great number of positive findings justifies the demand for careful radiographic examination also in case of clinically edentulous alveolar processes prior to the planning of any stomatological treatment.


[Problems of radiographic documentation]. This paper aims at describing the present situation in the field of radiograph documentation such as is typical of some clinics in the GDR. Furthermore, a suggestion is given that involves the possibility of reducing all sizes of radiographs (especially those greater than dental radiographs) to the size of 10 X 10 and of mounting their copies on punched cards (window principle). These copies can be enlarged and presented on a monitor. Other techniques such as video tape storing are not dealt with.


Clinically silent anterior uveitis in secondary syphilis. 1 In a series of twenty patients with secondary syphilis, ten showed signs of overt or subclinical iritis alone. Nine showed signs of purely subclinical iritis. 2 Nineteen were Caucasian men and the one woman was an unmarried Caribbean nurse. 3 Of the nineteen men, fourteen were homosexuals. 4 All received adequate anti-syphilitic treatment as soon as the diagnosis was made, and all ocular signs of inflammation disappeared within 14 days.


Uveitis and intraocular lenses.

Uveitis and intraocular lenses. Discs of polymethylmethacrylate containing 0-5 per cent. unpolymerized monomer were heated to create increasing concentrations of unpolymerized fragments up to 3-7 per cent. These fragments were then studied in tissue culture and in the anterior chambers of rabbits. No toxicity was evident in culture nor was there a difference in anterior segment response to the discs containing various concentrations of monomer. It would appear that the inflammatory response after implantation is predominantly mechanical in origin.


Survey of the first-degree relatives of glaucoma patients. Family histories were taken from 124 index patients, who had presented with either angle-closure or open angle glaucoma to the University Department of Ophthalmology, Manchester, between 1967 and 1972. Their first-degree relatives numbered 886, i.e. siblings, offspring and parents. Relatives were contacted by post and asked to attend for eye examination. Out of a total of 886 relatives, only 187 relatives were actually examined. The reasons for this low attendance rate are discussed; e.g. 423 relatives had already died.


Preliminary experience with lid magnets for paralytic lagophthalmos. Between February, 1974, and mid-December, 1975, 43 patients with paralytic facial palsy were operated upon with lid magnets, according to a method first devised by Mühlbauer and others (1973). When 37 patients were re-examined 3 months to 2 years post-operatively, 27 had both magnets in situ functioning well. In nine patients one or both magnets had been removed because of return of 7th nerve function. Including our information about those patients not available for re-examination, the method has definitely failed in only four. Cosmetically and functionally the results are subjectively as well as objectively encouraging and appear superior to a lateral tarsorrhaphy.


Proplast implant in Tenon's capsule after excision of the eye. Hitherto implants used after enucleation have generally been extruded because of infection or tissue rejection. Proplast, an inert alloplastic material prepared from a combination of Teflon fluorocarbon polymer and vitreous carbon fibres, is a grey felt-like material which, when wholly implanted, is invaded by fibrous tissue and not rejected. Hemispherical implants of Proplast have been used in sixteen cases, no rejection has occurred to date (18 months), and movement of the implant has been good. At operation, the obliques are sutured posterior to the implant so as to hold it forwards and increase movement. The rectus muscles are sutured anterior to the implant in cruciate fashion. Tenon's capsule and the conjunctiva are closed separately.


Vascular changes after retinal branch vein occlusion. I have described the vascular changes after retinal branch vein occlusion and have shown progressive changes both in the large retinal vessels and in the capillary bed. The capillary reactions are comparable to those seen in central retinal vein occlusion. Retinal oedema due to capillary dilatation and leakage occurs in both conditions but, whereas this is generalized in central retinal vein occlusion, local changes occur in branch vein occlusion. Capillary closure also occurs in both conditions, but the neovascular response differs. In branch vein occlusion significant new vessel formation is restricted to the retina leading to recurrent vitreous haemorrhage. This contrasts with central retinal vein occlusion in which thrombotic glaucoma due to predominantly anterior segment neovascularization is the most serious cause of visual loss.


Morgagnian cataract.

Morgagnian cataract. It appears that morgagnian cataract is a special form of cortico-nuclear cataract. It is assumed that the process of fibre dissolution which is encountered in cortical cataract in general is speeded up and occurs en masse in morgagnian cataract. Enzymatic degradation of membrane and crystallin fibre components could then occur to produce liquefaction of the fibres and resorption of the cortical fluid. Factors responsible for the resistance of the nucleus to this process have been discussed. The high levels of calcium in the capsule and nucleus in this form of cataract could be due to the precipitation of calcium orthophosphate in the capsule and of calcium oxalate in the nucleus.


Equatorial giant tears affected by massive vitreous retraction. Giant equatorial tears are frequently affected by massive vitreous retraction and the signs of this are easy to see. Liquid silicone is indicated at the stage of immobilization of giant tears complicated by massive vitreous retraction, and the use of this material is justified, for its properties allow the solution of the difficult problems presented by these tears; lastly, there is no evidence that liquid silicone is in any way harmful to the human retina.


Continuous infusion of the conjunctival sac with pilocarpine in normal subjects and in patients with chronic glaucoma. (1) A drug solution can be infused into the conjunctival sac by a simple method that does not cause overflow of solution. (2) At near neutral pH, pilocarpine infused at 1 mug/min was as effective as a single dose of 125 mug as a pupilloconstrictor in normal subjects. (3) At near neutral pH, pilocarpine infused at 10 mug/min was as effective as a single dose of 1 mg as an ocular hypotensive in cases of chronic simple glaucoma. (4) The infusion system described could find application in those situations in which it is essential to maintain a known and constant concentration of drug in the conjunctival sac.


Continuous infusion of the conjunctival sac with chloramphenicol in preoperative cataract patients. (1) Administration of a drug solution to the conjunctival sac by means of continuous infusion through a fine-bore silicone elastomer tube has been shown to be a simple and practical method in hospital inpatients. The use of a body-borne clockwork-driven syringe ram allows the patient to be ambulant. (2) The use of continuous infusion reduces the nursing supervision required compared with repeated administration of drops. (3) Further work will be needed to established the optimum concentration of chloramphenicol needed to equal that achieved by repeated instillations. (4) The flow rate of the infusion producing no overflow, particularly in elderly patients, is likely to be less than 0-01 ml/min.


Peripheral argon laser iridectomy in narrow-angle glaucoma. Gas argon laser peripheral iridectomy was attempted as an alternative to surgical peripheral iridectomy in the treatment of acute angle-closure glaucoma and the prophylactic treatment of fellow eyes. Success was achieved in eyes with a blue iris if sufficient energy was given to achieve a permanent red reflex. Reasons for failure in eyes with a heavily pigmented iris are discussed. The procedure must be greatly improved before surgical peripheral iridectomy is superseded as the treatment of choice.


Changes in composition and metabolic activity of the skeletal parts of the extremity of the adult rat following resection of the sciatic nerve. Resection of the sciatic nerve in adult male rats resulted in characteristic changes of the bone mass and the percentage composition of the tibia and the femur of the denervated leg. These changes were studied for a period of 1 to 16 weeks after the denervation. The tibia of the denervated leg underwent a significant decrease in bone mass, a significant increase of its percentage water and organic contents, and a significant decrease of its percentage ash content. The specific activity of the tibia showed irregular development with no significant slope. The femur of the denervated leg also underwent a significant decrease in bone mass and a significant decrease of its percentage ash content, while differences in percentage water and organic contents showed no significant slope. The specific activity of the femur showed a positive linear regression with negative values initially and positive at the end of the experiment.


Changes in composition and metabolic activity of the skeletal parts of the extremity of the adult rat following immobilisation in a plaster cast. Immobilisation of the one hind leg in adult male rats was followed by characteristic changes of the bone mass and the percentage composition of the tibia and the femur of the immobilised leg. These changes were studied during an immobilisation period of 1 to 24 weeks. The tibia of the immobilised leg showed significant loss of bone mass expressed as a decrease of its organic and ash weights as compared with the tibia of the non-immobilised leg. There was a significant increase of its percentage water content and significant decrease of its organic and its ash contents. The specific activity of the tibia was increased throughout but the increase was independent of time. The observed changes in bone mass and in percentage composition of the femur of the immobilised leg were almost identical with those of the immobilised tibia. The specific activity of the femur showed a positive almost linear regression. There were observations indicating that the skeletal changes recorded for the tibia were progressive during the period of observation. The changes noted in the femur seemed to be stabilised or even somewhat declining towards the end of the experiment.


Chemical composition of the skeletal parts of the extremity of the adult rat following below-knee amputation and immobilisation in a plaster cast. The chemical composition, i.e. ash and calcium contents and organic, hydroxyproline, and hexosamine contents of the acetone-dried diaphyseal cortical bone powder of the tibias and the femurs, was studied in adult rats after a) below-knee amputation and b) immobilisation of the one hind leg in a plaster cast. There were no significant differences in the chemical composition of the chemical composition of the bones of the treated extremity as compared with the corresponding bones from the non-treated control leg, either at different times after the amputation and immobilisation, respectively, or when all obtained values from each bone were tested together. The percentage hydroxyproline content of the tibia was found to be significantly higher than that of the femur in both extremities, both in the amputation and in the immobilisation experiment. The pro mille hexosamine content of the tibia, on the other hand, was significantly lower than that of the femur in both extremeities in the immobilisation experiment.


Studies on the volume and the activity of the parathyroid glands in osteoporosis of disuse in the adult rat. Inactivity of the right hind leg was brought about in adult male Sprague-Dawley rats by a) immobilisation in a plaster cast and b) by resection of the sciatic nerve. Determinations of the volume and the activity of the parathyroid glands by morphological methods showed that the parathyroids were, on the whole, not affected by the treatment. Some significant differences observed in some examined parameters should, however, suggest hypofunction of the glands. The serum-calcium level was significantly higher in the treated than in the control rats in the first experiment. No significant differences in serum calcium between treated and control animals were observed in the second experiment. These observations were considered to indicate that the development of localised osteoporosis in these two forms of inactivity did not depend on hyperactivity of the parathyroids. The observed differences in serum-calcium content between the two experiments may suggest that localised osteoporosis in the two cases developed through different pathomechanisms.


The effect of remobilisation on the extremity of the adult rat after short-term immobilisation in a plaster cast. The one hind leg of adult male rats was immobilised for 4 weeks in a plaster cast. The cast was then removed and the leg was subsequently remobilised for 4 and 16 weeks respectively. Studies of the skeletal mass of the femur and the tibia from the immobilised leg showed that after 4 weeks of remobilisation there were still clear signs of osteoporotic changes of the bones as compared with the corresponding bones from control non-immobilised rats. After 16 weeks of remobilisation there were no esteoporotic changes detectable by the methods used.


Changes in composition and metabolic activity of the skeletal parts of the extremity of the adult rat following below-knee amputation. Below-knee amputation in adult male rats resulted in characteristic quantitative and qualitative changes of the tibia stump and of the femur in the amputated leg. These changes were followed for periods of 1 to 32 weeks after the amputation. The femur of the amputated leg underwent a significant reduction of its total bone mass and a significant decrease of its percentage ash content, whereas its percentage water and organic contents increased significantly. The bone specific activity was initially decreased and began to increase after the 10th week post surgery with a positive linear regression. The amputated tibia underwent a significant, though declining, increase of its percentage water and organic contents and a likewise significant decrease of its percentage ash content. The specific activity of the amputated tibia was significantly higher than that of the tibia from the non-amputated leg, the difference showing a negative linear regression. The specific activity of the femur was decreased initially and increased later on.


Mobile intensive care unit. Present conception and realisation. A new Mobile Intensive Care Unit has been put in use at the "Service 900" of the Ministry of Health in Belgium. Its size was decided to enable efficient treatment of one patient. The type of suspension was chosen to give the patient adequate protection against untoward effects of travelling sickness. Radio-communication with the control center and hospital is ensured. The O2 supply-system provides an autonomy of 11 hours. Besides an electric distribution of 12 V. DC, a 220 V. AC is also available.


Turku sugar studies XI. Effects of sucrose, fructose and xylitol diets on glucose, lipid and urate metabolism. The effect of chronic consumption of sucrose, xylitol and fructose on lipid, carbohydrate and urate metabolism was studied in conjunction with a clinical trial on the effects of these sugars on dental caries. No consistent differences were found in serum triglycerides, glucose, insulin, urate, lactate, or pyruvate concentrations or in the urinary excretion of urate between the groups using sucrose, fructose or xylitol as the dietary sweetener. Serum cholesterol tended to be lower in the fructose than in the xylitol group, but the difference disappeared when subjects with initial high serum cholesterol in the baseline examination were excluded from the calculations. The results suggest that the effects of peroral fructose and xylitol on the metabolic parameters studied in this investigation do not differ from that of sucrose.


Turku sugar studies XIII. Effect of the diet on certain clinico-chemical values of serum. Pooled and individual serum samples of subjects on long-term sucrose, xylitol and fructose diets were analyzed for Ca, Mg, K, Na inorganic phosphate, bilirubin, ascorbate, alkaline and acid phosphatase, amylase, transaminases, lactate dehydrogenase, and amino acids. Most serum samples were obtained from the last phases of the two-year dietary regimen. Significant differences between the three experimental groups were not found with regard to any of the compounds or enzymes studied. Almost significant differences were observed for amylase which was lower in the xylitol and the fructose groups than in the sucrose group, all these values being within the normal range. The results indicate that xylitol and fructose do not induce significant changes in liver function tests, nor in serum level of electrolytes, ascorbate or serum enzymes when their oral administration takes place in the same scale as that of sucrose.


Familial nephropathy associated with hepatic type of glycogen storage disease. The female patient was diagnosed as having Von Gierke's disease at 14 years of age, based on clinical manifestations, laboratory examination and liver biopsy. At 19 years of age she had uremia and died from its deterioration at 24 years of age. The parents were consanguineous, and a 27-year-old sister is presently hospitalized for renal insufficiency with hepatomegaly. On autopsy, the patient's kidneys were highly contracted and contained a number of small cysts, mainly in the medulla. Histological examination indicated periglomerular fibrosis, glomerular hyalinization, tubular atrophy or cystic dilatation and intersitial fibrosis with round cell infiltration. These findings correspond to Fanconi's familial juvenile nephronophthisis, except for age. The liver was markedly enlarged and indicated severe, glycogen deposits, but the kidney did not contain glycogen deposits. It can, therefore, be presumed that the renal lesions were not a secondary consequence of long-term glycogen deposits but that renal and hepatic lesions were associated with each other.


Respiratory failure in pregnancy.

Respiratory failure in pregnancy. A case of respiratory failure in pregnancy associated with old poliomyelitis is presented and the available methods of treatment described.


Intermittent mandatory ventilation with "Manley" ventilators. A method is described whereby gas powered, minute volume divider, ventilators may be adapted to provide intermittent mandatory ventilation.


[Acute monoblastic leukemia. Clinical and therapeutic aspects in 20 cases]. Twenty cases of acute monoblastic leukemia are studied according to definite criterias: cytology, cytochemical staining, lysozyme production. The study points out the tumoral characters: hematodermy, gingivitis, central nervous system leukemia and the lack of important bone marrow incompetence. 47 per cent of complete remissions are obtained with daunorubicin, aracytin combination therapy. Other useful chemical agents, and prospects for maintenance therapy are discussed.


Brain architecture and mechanisms that underlie language: an information-processing analysis. A neural network model for naming visual objects and their attributes, and understanding certain simple types of sentences has been presented. The model is based on neural processes rather than linguistic or symbolic constructs. The following are the major structural features of the model: 1. Memory stores are associative networks that perform an analysis of their inputs in real time. This analysis converts the input pattern into a "recognition pattern" that depends on the specific stored information and its location in the store. 2. The naming store is an analyzer network that converts the sensory encoding of a sentence into a "sentence pattern". The sentence pattern is obtained by averaging the recognition signals from several memory locations in the naming store. Because of the organization of words in the naming store, sentence patterns are an encoding of the structure of the sentences. 3. The sentence store is an associative memory store that recognizes sentence patterns and associates with each one an "instruction sequence" or "program" that specifies how the system should respond to the sentence. It is the enabling of access to this "program" that constitutes "understanding." Sentences are understood in real time, without the explicit grammatical analysis that is usual in sentence-understanding systems. Understanding a sentence involves two functionally distinct processes: (1) associating with its sentence pattern an instruction sequence that specifices what to do in order to generate an appropriate response to the sentence matching that pattern: for example, to look in the visual field for an object, determine its location, and so on, and (2) analysis of the tokens in the sentence that indicate specific attributes or entities to look for or determine.


Two faces of sign: iconic and abstract.

Two faces of sign: iconic and abstract. In this paper, we show that the total range of the communication system of the deaf is considerably enriched but at the same time rendered more difficult to analyze, because pantomime and other spontaneous nonsign representations occur in the same mode as regular ASL signs in deaf discourse. We note that the rarification of what was originally nonsign depiction is clearly an important source of regular ASL signs. We show that criteria can be established that would distinguish the clear cases of pantomime from the regular ASL signs. Nonetheless, there remain a sizable number of regular ASL signs which, although they are neither pantomimic nor otherwise freely mimetic, still appear to retain an iconic cast. We show that very few ASL signs are actually transparent; that is, a nonsigner cannot guess the meaning of a sign in the absence of further information. On the other hand, many signs are iconic in the sence that nonsigners, when given the sign and its meaning, show considerable agreement in how the two are related. More important in terms of language and its users is the significance of iconicity for deaf signers themselves. This paper shows that while in special circumstances the deaf do play on iconic elements of certain signs for special effects, iconicity plays no observable role in the coding of signs in short-term memory. The abstract formational parameters definitely dominate. We further note that it is the abstract system and not purely iconic aspects that have determined observed historical changes in the form of ASL signs. We interpret this as indicating the deeper structural significance of the abstract formational level. Finally, we show that very widespread and productive grammatical processes, especially suited for a visual-gestural language, override the iconic aspects of signs also at the synchronic structural level.


Cerebral asymmetry: changes in factors affecting its development. The present study offered further support for the notion that hemispheric differences are present during early infancy. Moreover, in addition to finding evidences are present during early infancy. Moreover, in addition to finding evidence of electrophysiological differences between male and female infants, discrete components of the AEP response were identified and isolated that were responsive to specific aspects of the acoustic stimuli. Information concerning temporal differences in the processing of these elements was also obtained.


[Comparison of altered states of consciousness induced by the hallucinogens (--)-delta9-trans-tetrahydrocannabinol (delta9-THC) and N,N-dimethyltryptamine (DMT) (author's transl)]. The study compares altered states of consciousness induced by the hallucinogens (--)delta9-trans-Tetrahydrocannabinol (delta9-THC) and N,N-Dimethyltryptamine (DMT) using two placebo control groups. A total of 24 subjects received 250 mug delta9-THC p.o./kg body weight and 26 subjects were treated with 250 mug DMT i.m./kg. Placebo was given to 24 subjects. The effects were assessed by a questionnaire administered following the experimental conditions. Questionnaire items were combined into the following eight scales according to their content and several cirteria of the theory of mental testing: visual hallucinations (illusions), auditory hallucinations (illusions), impairment of memory and attention, depersonalization syndrome, deprealization syndrome, changes of body image, euphoric state and anxious-depressive state. The two hallucinogen groups differed significantly from placebo on all eight scales. No difference, however, between delta9-THC and DMT was significant. On the scale "optical hallucinations (illusions)" a tendency that DMT might have stronger effects than delta9-THC was found. Methodological problems of comparing different hallucinogens are discussed.


[Electron microscopic study of cell elements and interstitial substance of osteogenic carcinoma]. The electron-microscopy investigation of osteogenic sarcomas of the osteoplastic type made it possible to identify 4 types of cells with a various ultrastructure. The cells of osteogenic sarcoma retain the ultrastructural specificity of skeletogenous cells and some features of tissue organization. This confirms once more the statement that osteogenic sarcoma is a derivative of the precursor of skeletogenous cells which underwent a tumour transformation.


The effects of tobacco smoking on oral and dental tissues. An attempt has been made in this paper to review the clinical problem of the effects of tobacco smoking on oral and dental tissues. Clinicians are alerted to the magnitude of the problem and to its serious sequelae. An appeal is made for clinicians to disseminate preventive information, to exercise increased clinical vigilance and to consider the management of suspected neoplastic lesions as emergency situations.


A community dental health project. II. Modification of Streptococcus mutans in dental plaque by self applied Snf2-ZrSiO4 prophylactic paste, and its relationship to dental caries. The incidence of Streptococcus mutans in the dental plaque of primary school children was reduced significantly following the group self application of SnF2-ZrSiO4 paste. This confirmed earlier reports of the effect of topical fluoride therapy on Str. mutans in plaque.


A simulated clinical appraisal of base materials for amalgam restorations. Eight materials were placed as bases on the pulpal surface of cavities prepared in extracted teeth. Seven minutes after mixing of the material commenced, amalgam was condensed on to the lined cavity. The restored teeth were sectioned subsequently for microscopic examination. The results suggested that all uniformly mixed, carefully placed base forming materials that have reached the state of "clinical set" are able to withstand loads applied during amalgam condensation irrespective of their strength.


Groote Eylandt studies. 2. Fluoridation of a small domestic water supply, C.M.S. Angurugu mission, Groote Eylandt, N.T., Australia. 1973-1974. A system is described for fluoridation of a small community water supply. The design of the equipment is presented in relation to the requirements of a particular isolated region and in a basis for application to other similar areas. The problems found during the establishment of this system and their solution can be valuable as a guide for other communities.


Direction of the mental canal in human mandibles. The direction of the mental canal was calculated in the horizontal and vertical planes with a view to aiding anaesthetic techniques. Based on our data, it is advisable to give the following approximate inclinations to the needle when penetrating the mental canal in anaesthetic procedures: 55 degrees postero-anteriorly in relation to a horizontal plane and 40 degrees latero-medially in relation to a horizontal line tangent to the body of the mandible at the level of the mental foramen.


Assessment of the status of endodontically treated teeth in patients with cardiovascular abnormality. The accuracy of conventional methods of assessing the periradicular tissues, especially important in the case of a patient with cardiovascular abnormality, is questioned. The results of histological assessment in 81 teeth are reported. The ideal of a biological obturation of the root canal is emphasized.


Dental survey of students at the Australian National University -- 1972. A sample of 422 students at the Australian National University was examined in 1972. Results for the 302 full-time student sample were considered significant and are presented in this report. The students were found to have a relatively low (for Australia) DMFT of 13.8, Oral Hygiene Index of 0.9 and Periodontal Index of 0.75. Seventy-two percent of students had attended a dentist within the previous year and F/DMFT ratio was 76 percent. Estimates of time and costs of treatment needs are presented.


Loss of upper permanent central incisor teeth. Case report. A case is reported in which elastic bands caused irreversible periodontal destruction around upper central incisor teeth. Every practitioner should be aware of the hazards associated with the use of elastic bands in minor tooth movement.


The potential role of bacteria and their antigens in periodontal disease. The inflammatory changes typical of periodontal disease are believed to involve immunological reactions, with bacteria being a potential source of the antigens inducing these reactions, with bacteria being a potential source of the antigens inducing these reactions. Various investigators have studied the ability of specific organisms to induce tissue changes in experimental animals, while others have examined human sera and tissues for the presence of antibodies reacting with particular organisms or their isolated antigens. The significance of these results is assessed, particularly with respect to the problem of antibody cross-reactivity. The antigens that could be involved in periodontal disease are discussed in terms of the difference in structure of Gram-positive and Gram-negative bacterial cells, with attention being drawn to those components that could occur extracellularly and thus diffuse into oral tissues. The antigen most studied is the lipopolysaccharide or endotoxin of Gram-negative cells which, through the mediation of complement, is a potential inflammatory agent.


Premalignant lesions of the oral mucosa. The term premalignant lesion is defined and an explanation of the logical use of the term leukoplakia is given. The more common premalignant lesions of the mouth are described. Known and suspected aetiological factors in the development of oral carcinoma are discussed. It is emphasised that oral squamous cell carcinoma is, very largely a preventable disease. Signs of premalignancy in the mucosa can usually be detected clinically and remedial action at an early stage is generally effective in eliminating the lesions and avoiding their recurrence.


Histological assessment of the temporomandibular joint. An histological assessment has been made of condyles removed at condylotomy. The tissue was removed from patients where conservative treatment had proved unsuccessful. In most of the condyles degenerative changes were found and in some, evidence of trauma. The importance of adaption is discussed. The need for proper pre-operative assessment is emphasised.


Fluoridation in Canberra. III. Dental caries after ten years. The water supply of Canberra was fluoridated in eptember 1964. This report covers the period 1965 to 1974 during which children aged five to twelve years were examined. These children had lived in Canberra since fluoridation commenced. In comparison with base-line data the results showed a progressive improvement in the DMF and defindices. The reduction in the DMF index for children aged six years who were examined in 1974 was 81.0 per cent, and for children aged twelve years it was 48.5 per cent. The reduction was greatest for incisor teeth.


Carcinoembryonic antigen (CEA), smoking, and cancer in a longitudinal population study. In 1969, the prevalence of raised levels (5 ng/ml of serum) of carcinoembryonic antigen (CEA) was estimated in 2372 persons aged 40 years and over in Busselton, Western Australia. There were raised levels of CEA in 73 subjects (3%). The prevalence increased progressively with age in both non-smokers and smokers with a higher rate of prevalence at all ages in smokers, and a peak of 11% in smokers aged 65--74 years. Among non-smokers, the prevalence was similar in both men and women (1%), in smokers there was a stepwise rise in prevalence with increasing tobacco consumption. Subsequently, levels of CEA of 5 ng/ml or over tended to disappear from the sera in a greater proportion of the non/exsmokers than of smokers. In the following five years, "CEA-associated" cancer occurred in nine of 73 subjects (13%) with raised levels of CEA compared with 25 in 2299 (1%) in those with normal CEA levels. This association was independent of the confounding effects of age, sex, and smoking habit. The five year data on 2372 subjects have confirmed that CEA screening of healthy Busselton subjects has identified a group at future risk of developing "CEA-associated" cancers, in addition to drawing attention to the presence of existing cancers.


A clinical evaluation of large-area short-time haemodialysis. A large-area short-time (LAST) haemodialysis regimen (three hours by three times per week on a 2-5 M2 haemodialyser) has been compared with conventional haemodialysis (six hours by three times per week on a 1-3 M2 haemodialyser) on four patients over a period of eight months. Parameters monitored throughout the study included: Serum biochemistries, haematocrit, extra-cellular fluid space, platelet function, granulocyte kinetics, immunological status and neurological status. All patients showed weight increases (3--12%) during the LAST dialysis period. These increases were related to problems of intradialytic hypotension which resulted from the increased rate of fluid removal required during the LAST dialysis period. Hypotension was not a problem during routine dialysis all patients showed an increase of 10--20% (P less than 0-05) in predialysis serum urea and creatinine and a moderate decrease in predialysis serum bicarbonate (from 24-8 +/- 2-2 to 21-4 +/- 2-6 mM/I, P less than 0-005). This study indicates that, providing fluid balance can be controlled, a LAST dialysis regimen provides comparable therapy to conventional haemodialysis. However, recent studies have suggested that short-time dialysis may be possible with conventional 1-0 to 1-3 M2 haemodialysers, indicating that short-time haemodialysis may not need to involve more costly large-area haemodialysers.


Histocompatibility antigens in Graves' disease. Histocompatibility antigen typing was undertaken in 100 Caucasian patients with Graves' disease (autoimmune thyrotoxicosis) and in 100 healthy Caucasian blood donors. Standard lymphocyte microcytotoxicity methods were used to tests for the presence of 22 HL-A antigens in all subjects. There was a significant difference between the groups in respect of the HL-A 8 antigen which was present in 40 patients and in 25 controls (P less than 0-0023). There was no significant difference between the patients and controls with respect to the frequency of occurrence of any of the other HL-A antigens tested.


Evidence that mouse thyroid stimulator does not stimulate the human thyroid gland. Thyroid 131I uptake and human thyroid stimulator (HTS) level were measured in 20 untreated thyrotoxic patients who also showed mouse thyroid stimulator (MTS) ACtivity. The correlation between thyroid uptake and HTS level was highly significant (P less than 0-005), the coefficient, r, being 0-66, comparable with the value 0-68 obtained in a previous study of patients not showing MTS. Thus, the presence of widely varying amounts of MTS does not impair the close correlation existing between HTS level and thyroid 131I uptake in thyrotoxic people. There was no correlation between MTS level and thyroid 131I uptake (r = 0-11, n.s.). It is concluded that MTS, a potent stimulator of the thyroid glands of mice, guinea pigs and monkeys, does not stimulate the human thyroid gland.


Goitre survey in Armidale and the New England region. The results of a goitre survey in school children in the New England Region are presented and compared with previous studies. Goitre incidence has fallen significantly in Tamworth but has remained unchanged in Armidale. Analyses of blood and urine showed no differnces in thyroid hormone levels, TSH, and urinary iodide in goitre and non-goitre subjects. In one group of goitre subjects prolactin levels were found to be significantly higher than those in a non-goitre group matched for sex, age and years in the district. The estimated iodine intake was well above normal requirements in all age groups studied. Sources of dietary iodine in the New England Region are outlined with special reference to milk and water. A brief review of clinical thyroid disease in Armidale is presented and reveals an unusually high incidence of both hyper- and hypo-thyroidism.


T3 toxicosis and its relation to the iodide status in Singapore. Baseline thyroid function tests (including total serum thyroxine iodide-T4I, total serum tri-iodothyronine T3 as well as T3 Sephadex Uptake Studies (T3U)) were determined in 82 normal Asian subjects. In addition, another group of normal volunteers (39) were assessed as regard serum and 24-hour urinary iodide levels to gauge the iodide status of the community; the results were comparable to that of goitre-free regions of the world. Having established the range of values of normal thyroid function tests, 103 consecutive clinically thyrotoxic patients (both new and relapsed cases) were similarly studied in an attempt to elucidate the magnitude of the problem of T3 toxicosis, and its relation to the iodide status in Singapore. Only three clinically hyperthyroid patients were foudn to have normal PBI T3 levels. A detailed analysis and discussion of the data is presented. It is concluded that T3 toxicosis is a rarity in Singapore.


Hypokalaemia occurring during insulin-induced hypoglycaemia. Insulin-induced hypoglycaemia was used to test pituitary function in six patients with suspected pituitary deficiency. In each, a fall in serum potassium concentration of from 0-63 to 1-48 mEq/litre (mean fall 1-10 mEq/litre +/- 0-30 SEM) was observed during the two hour period following administration of 1-15 units of insulin per kilogram body weight. In several patients the resulting hypokalaemia was at a level which has been associated with cardiac complications.


Diabetes mellitus and tropical form of chronic calcific pancreatitis in Thailand. Six cases of chronic calcific pancreatitis in Thailand occurring in patients aged 13 to 22 years are reported. Protein malnutrition was a possible aetiologic factor. Abdominal pain was mild to moderate and intermittent and not a presenting feature. Severe diabetes mellitus was present at all. Extensive pancreatic calcification was seeen on abdominal X-ray.


Thorotrast-induced haemangioendothelial sarcoma--a lesson from the past. Complications following a carotid arteriogram done in 1947 with Thorotrast are described in a 47-year-old man who subsequently died from them in 1970. They included a local cervical granuloma with associated haemangioendothelial sarcoma, chromosome changes characteristic of radiation damage and widespread haemangioendothelial sarcomatous deposits in brain, lung, liver, probably arising from multicentric primary sites in the bone marrow. A survey of the use of Thorotrast as a contrast medium in Australia and New Zealand showed that its use was extremely limited. The prinicpal complications seen have been two cervical granulomas and one hepatoma.


Myocardial infarction in Wegener's granulomatosis. A case is described of a 28-year-old man who presented with a picture of classical Wegener's granulomatosis; and who, in the absence of fulminating renal or respiratory disease died from myocardial infarction. Other reports of cardiac involvement are discussed and compared with the picture presented by this patient.


An unusual case of local gigantism.

An unusual case of local gigantism. A 38-year-old female with an unusual degree of gigantism of the left leg is described. There was no other known association. Angiogram did not reveal any abnormality. The patient refused surgical intervention.


Complement and the clinician.

Complement and the clinician. The estimation of complement in serum, and in other body fluids, particularly synovial fluid, now has an established place in the assessment, prognosis and response to treatment of those diseases associated with immunological phenomena. Some knowledge of the complement sequence itself, the patterns characteristic of various disease processes and the interacting factors which may affect the levels of the various components have been summarised. Disease states closely resembling lupus erythematosus have been associated with genetically determined deficiencies of classic pathway components and deficiencies of terminal sequence components may lead to severe recurrent infections.


Drug interactions in the management of rheumatoid arthritis. Only some of the areas of drug interactions of relevance to those treating rheumatic diseases have been mentioned and there are still enormous gaps in our knowledge. It is likely that some potential areas of danger have been over-emphasised, being based on speculation rather than real data or purely animal experiments using non-clinical doses of drugs. We are learning how certain drugs can stimulate or inhibit the metabolism of other drugs through effects on liver enzymes systems. For example, the metabolism of corticosteroids is induced by phenylbutazone (and also by phenobarbital and phenytoin). The patient with active rheumatoid arthritis with a low serum albumin would be unusually susceptible to changes induced by combinations of highly protein-bound anti-inflammatory drugs. Finally, although drug interactions are responsible for adverse effects it has been suggested that a more frequent cause of therapeutic failure is not drug interactions but the increase in the number of drug defaulters when more than one drug is prescribed.


Pathology, aetiology and pathogenesis of analgesic nephropathy. 1. The initial site of damage in analgesic abuse is the renal medulla and the characteristic lesion is renal papillary necrosis. The papillary necrosis appears to be an ischaemic infarct. The cortical lesion of chronic interstial nephritis is a non-specific change and secondary to obstruction to tubules in the necrotic medulla. 2. Medullary perfusion and the concentration mechanism appear to be important factors in the genesis of renal papillary necrosis. 3. Experimental and clinical studies suggest that abuse of compound analgesics containing aspirin, phenacetin and caffeine result in renal papillary necrosis and the clinical syndrome of analgesic nephropathy. In the APC mixture aspirin appears to be the major nephrotoxic agent while phenacetin plays a synergistic but secondary role in the renal nephrotoxicity.


Does aspirin play a role in analgesic nephropathy? Using a compound analgesic mixture, it was found that renal pathology could be produced in rats if the analgesic mixture was administered as a concentrated aqueous suspension, but that development of renal pathology was not favored by hot, dry environmental conditions. Determination of whole body total salicylate concentrations in rats and humans receiving various doses of aspirin revealed that twice daily doses of 24, 60 and 125 mg/kg aspirin in the rat were equivalent to human doses of 8, 20 and (approximately) 40 ordinary 325 mg aspirin tablets daily. These doses of aspirin were then employed in a subchronic study of the nephrotoxicity of aspirin in the rat using the experimental design which maximized the nephrotoxic effects of the compound analgesic mixture. Six groups of ten male and ten female rats received aspirin orally at doses of 24,60 or 125 mg/kg twice a day five days a week for 12 weeks. Two additional groups of ten male and ten female rats received only the vehicle, at a volume equivalent to that received by the high dose group, and served as controls. Four groups (one each, control, low, mid-, and high dose) were denied access to water for 16 hours daily overnight. No pathologic renal changes were observed in any of the rats. These findings are consistent with a growing body of evidence, from both animal and human studies, that aspirin alone does not produce analgesic nephropathy.


Mental health services by and for Austrailian aborigines. Based on a program developed for the Papago Indians of Arizona, five Australian Aborigines were trained as Behavioral Health workers, to deliver mental health services to their group. The problems of the Aborigines are very similar to those of the Indians. The training consisted of developing basic skills in interviewing, case indentification and several methods of intervention, including crisis intervention, family and alcoholism counselling. A mental health clinic was developed for the Aboriginal community for health services and training. Community projects and field trips were part of the training, as was report writing, record keeping and presentations to professional groups.


Social geography of suicidal behaviour in Hobart. Psychological notions are required to explain geographical patterns. Mapping and statistical analysis for years 1971, 1973, 1974 and half of 1975 revealed that attempted suicide occurs commonly in the area surrounding the central business area of urban Hobart and also in the older housing department areas. Physical patterns and social structure are related in a tangible way for the expression of suicidal behaviour in a spatial pattern.


Family interaction and adolescent suicidal behaviour: a preliminary investigation. While investigators have emphasized the importance of familial relations in the production of suicidal behaviour in adolescence, experimental evaluation of specific family interaction processes has, thus far, been neglected. The aim of the present study was to investigate possible relationships between adolescent suicidal behaviour and total on-going family functioning. Hypotheses were advanced to evaluate the communication, interaction and reinforcement patterns in families. A modified revealed differences technique was employed to elicit standardized segments of interaction which were video-taped and later studied by two independent raters. The sample consisted of twelve individually matched, intact family tetrads, six normal (N) and six containing an adolescent female who had exhibited suicidal behaviour (SM). Results suggest that SM families constitute a malfunctioning system which can be differentiated from that of normal samples. As compared with the N group, SM family interaction evidenced less effective productivity, specificity, and adaptive interaction, and higher rates of conflict and negative reinforcement. Overall findings were discussed in terms of current family theory and their possible relationship to the genesis, maintenance and management of some classes of suicidal behaviour.


Borges, Luria and hypermnesia--a note.

Borges, Luria and hypermnesia--a note. Similarities between a fictional and an actual case of hypermnesia are presented. The question whether the fictional character could have been based on the real person is considered from various angles. No definite conclusion is reached.


Conners Teacher Questionnaire--norms and validity. A random sample of Auckland elementary school children (N=418) were rated by their teachers on Conners Teacher Questionnaire, one of the measures recommended by the National Institute of Mental Health for use in drug studies with children. Norms were found to be comparable with a New York sample on two of the four factors but children from a Midwestern university town differed substantially from the New Zealand and New York groups so that further standardisation work is necessary. A replica of Conners factor structure was also attempted and the results compared additionally with a similar U.S. study. It was concluded that despite some definite differences, the original factor structure appeared sufficiently stable across studies not to change the present scoring system except to add the Sociability Factor. The tendencies for boys to be rated higher on acting out type behaviors and girls on neurotic symptoms is consistent with clinical experience and previous studies.


Evaluation of an inpatient service by consumer feedback. Over the past few years, the Sound View-Throgs Neck Community Mental Health Center has conducted a number of studies of client satisfaction with our services. The findings suggest that the majority of clients are generally satisfied with the help they receive. However, the level of satisfaction apparently depends on specific aspects or features of the program being evaluated, as well as the particular unit which is providing the services. We have used face-to-face, telephone, and mail survey procedures in these studies; and we have sampled both clients who have completed their treatment and those in the early phases of the treatment process. In one of the studies, the former SVTN-CMHC patients we surveyed had been hospitalized in the inpatient unit located at Bronx Municipal Hospital Center. We randomly selected one hundred patients who had been discharged from the unit during the first six months of 1971. After excluding children under the age of sixteen, patients who were subsequently hospitalized or were too symptomatic to be interviewed, and those living outside New York City, we interviewed twenty-five ex-patients. We asked questions about their feelings related to the need for hospitalization, their present problems, whether hospitalization had helped them, their satisfaction or dissatisfaction with ward life, and their feelings about discharge. The results indicated that these ex-patients felt at least moderately satisfied with their hospital experience. However, they were relatively dissatisfied with provisions for privacy on the ward, the fact that doctors and other hospital staff were not readily available to them, the doctor's understanding of their problems, and the evening recreation programs. There was some discrepancy between the ratings, which were mostly favorable, and the comments, which were predominantly unfavorable. There are various possible explanations for this, ranging from the limited validity of rating items in such a study to the possibility that this group of ex-patients were so accustomed to negative experiences that their overall assessments were not significantly influenced by them. There is some possibility that the highly positive ratings may stem from an unexpected source. For approximately half of the sample, the major purpose of hospitalization was to provide an opportunity to get away from their usual surroundings. The in-hospital treatment per se was relatively unimportant to them, and their favorable ratings may be a way of indicating that the hospital simply served as a refuge, which they were seeking. Since a patient may approach the hospital with self-defined needs either for treatment or mainly for refuge--it may be worth while to provide alternative programs to meet these different needs. A "refuge" program, for example, may not require an in-hospital environment; and even if it does, the staffing pattern should be different from that of a hospital with a treatment-oriented program.


Risk-taking propensity, depression and parasuicide. One hundred patients admitted consecutively to an inpatient psychiatric unit were given questionnaires to measure risk-taking propensity and depression. The purpose was to study the relationship between risk-taking, depression, and recent suicide attempts. It was found that depressed patients showed a bimodal clustering towards the extremes of risk-taking. There was a history of suicide attempts only when a certain threshold of risk-taking was exceeded. These findings are discussed with relation to defensive styles of psychological adaptation and to arousal thresholds.


The Little Nell Complex--an Oedipal variant. An oedipal relationship between a girl and her grandfather might be named the "Little Nell Complex" after Dickens' description of the close relationship between thirteen year old Little Nell and her grandfather in "The Old Curiosity Shop". A clinical illustration of a Little Nell Complex is described in a seventeen year old girl who presented with depression following the death of her grandmother. Oedipal complexes existing between the patient and her parents, the patient and her grandparents, and between the patient's mother and her parents, are described. In offering notations the "erotic" component of the Oedipus complex has usually received more attention than the "attachment" component. It is felt that Bowlby's concepts of attachment behaviour may be useful in the consideration of oedipal behaviour and in the structuring of therapy.


Unexpected recoveries from chronic severe psychiatric illness during treatment by psychological modes. Four patients with psychotic illnesses and two with obsessional neuroses made unexpected recoveries attributable to psychological processes. They had been ill for periods ranging from 6 months to 19 years before first seen. All had physical therapies of several kinds including one who had approximately 500 ECT and another who had bimedial lobotomy. Follow-up after recoveries ranged from 6 to 24 years. In two cases psychotherapy (psychoanalytically orientated) was significant. Changed family dynamics, the support of a psychopomp, and the mobilisation of previously unrealized ego-resources were other significant psychological processes. Exhaustive re-evaluation of patients resistant to physical therapies is urged.


A preliminary study on humoral control of granulopoiesis in primary myelofibrosis and chronic granulocytic leukaemia. The extent of the urine Colony Stimulating Factor (CSF/u), as well as the Colony Stimulating Activity (CSA) of peripheral-white blood cells (WBC) were evaluated in two groups of patients with myeloproliferative disorders, at the disease onset. The first patient group deals with Primary Myelofibrosis (PM), whereas the second group deals with Chronic Granulocytic Leukaemia (CGL). The Stanley technique was used for the above-mentioned assay, and in each group of patients either human or murine bone-marrow cell-suspensions were cultivated. In all patients with PM, a low CSF/u was detected, while patients with CGL showed a high CSF/u, regardless whether Ph1-positive or not. CSA of WBC in the PM-group was normal. In contrast, a significant low CSA in the CGL-group was noted. This fact could be of some importance in differentiating the two disorders at their onset.


Cytotoxic antibodies to human leukaemia cells in normal human sera. Antibodies cytotoxic for human leukaemia cells were demonstrated in the serum of normal individuals: two of them being the fathers of leukaemia children, the third one being a normal unrelated donor. One of these sera (obtained from the father of an eight years old girl with acute myeloblastic leukaemia) appears to react widely with cells from acute leukaemias, both lymphoid and myeloid. On the other hand, the serum obtained from the normal blood donor appears to react almost exclusively with cells from acute lymphoblastic leukaemias, and more especially with those which do not form rosettes with sheep red cells.


Deoxyribonucleases activities in human leukemic cells and mouse lymphoblasts. The deoxyribonuclease activities from human lymphocytes have been compared with the activities from acute lymphocytic leukemic cells and mouse leukemic cells L5178Y using the in situ detection of deoxyribonucleases in DNA-containing polyacrylamide gels following their separation by micro-disc-electrophoresis. A neutral deoxyribonuclease activity is completely missing in leukemic cells of untreated patients while a group of acid deoxyribonuclease activities is increased. A similar deoxyribonuclease pattern can be seen in L5178Y cells. Under medical treatment the increment of the acid deoxyribonuclease activities disappears and the neutral deoxyribonuclease activity reappears.


Acute nonlymphocytic leukemia associated with nitrosourea chemotherapy: report of two cases. Acute nonlymphocytic leukemia developed in two patients who were treated postoperatively with cytotoxic chemotherapy. Both patients survived more than 4 years after the diagnosis of brain tumor, and both had extended periods of myelosuppression secondary to nitrosourea chemotherapy. Nitrosourea therapy may have facilitated the development of acute leukemia in these patients.


[Transient blood modifications of glycolysis in hypercapnic patients with artificial ventilation (author's transl)]. Ten patients with respiratory insufficiency (mean age: 63 years) are studied during the first 12 hours of intubation and assisted ventilation by a strong volumic respirator (Bennett MA1, FIO2: 0.40). Arterial blood samples are taken before, and after 30 min, one, two, four, six and 12 hours of assisted ventilation, for measurement of blood gases, acid-base equilibrium, haemoglobin and haematocrit, and, by various enzymatic methods, of lactate, pyruvate, ATP and 2,3-DPG concentrations. The PaCO2 rapidly decreases from 75 to 44 mmHg within 30 min ventilation. At the same time, SH+] decreases from 50 to 34 nmol/l. This "reventilation alkalosis" is still more marked later on (PaCO2: 34 mmHg; H+: nmol/l at the sixth hour). The mean PaO2 remains to about 70 mmHg during the assisted ventilation. The glycemia varies little and remains at a high level (140 mg%). The arterial blood lactate concentration progressively increases (from 1.6 to 2.5 mmol/l) at the second hour of ventilation, then decreases to 1.8 mmol/l at the 12th hour. The arterial blood pyruvate concentration also increases, with a peak at the fourth hour. The 2,3-DPG concentration significantly increases from the fourth hour on, whilst the blood ATP decrease is already significant at the first hour of assisted ventilation. These transient changes in glycolysis in chronic hypercapnic patients during assisted ventilation are similar to those observed in the dog when PaCO2 is rapidly normalized after a long term hypercapnia.


Tumor detection in extremities of man with 99mTc-tetracycline. Twelve patients with tumors and three with osteitis of the extremities were studied using 99mTc-labelled tetracycline in order to image the process with gamma camera. The diagnosis of all cases were verified histologically. The labelled tetracycline was found to give positive images for the most malignant tumors and active osteitis which together comprised about half of the studied cases.


Myelodysplasia: the natural history of kyphosis and scoliosis. A preliminary report. The results of this study support the concept that the levels of the bifid vertebral arch and of functional motor activity are significant influences on the development of scoliosis and kyphosis in patients born with myelodysplasia. 'Significant' degrees of scoliosis and kyphosis may appear at any time during life, but most frequently occur during late childhood or adolescence. Not all 'significant' curvatures require treatment, nor do all children with myelodysplasia and factors predisposing to kyphosis and scoliosis develop these complications. It is believed that the preliminary cumulative percentage curves presented in this study will be of value in counselling parents of afflicted newborn infants, and in planning the management of patients born with myelodysplasia.


Gliosis and aqueductule formation in the aqueduct of Sylvius. A study was made of the cerebral aqueducts of 30 children with hydrocephalus but without myelomeningocele. A sequence of events is demonstrated which suggests a mechanism of aqueductule formation and burial of ependymal cells. The cellularity of areas of gliosis may normally decrease and resemble normal neural tissue, but occasionally activity is perpetuated by continuing irritants. The only evidence of gliosis long after the event may be the presence of buried ependymal cells or aqueductules, The presence of a small aqueductal 'ghost' and ciliated columnar epithelial lining suggests an intra-uterine timing of the insult.


Preliminary studies on the impregnation of silastic elastomers with antimicrobial substances. This study of the effects of various factors on the antibacterial activity of gentamicin-impregnated Silastic has shown that it is unaffected by autoclaving and storage. It has also shown that this activity persists for long periods under crudely simulated in-use conditions. This form of Silastic will be studied further in an attempt to evaluate the kinetics of gentamicin diffusion within it, and to investigate its possible use in preventing colonisation of Holter shunts.


Once a shunt, always a shunt?

Once a shunt, always a shunt? Over a period of 15 years, during which some 1000 operations were performed, CSF-drainage systems were able to be removed in 40 of a total of 444 children with communicating hydrocephalus or hydrocephalus associated with myelomeningocele. Shunts were removed from 26 children in the former group, of whom 17 continued to be compensated; in the latter group there were 14 removals, all of whom remained compensated. It is stressed that true compensation can be proven only by continuous measurement of ventricular fluid pressure over periods of several hours or at intervals of days or weeks, and four cases are discussed in which decompensation occurred, in two cases with fatal results.


Skull changes and intellectual status in hydrocephalic children following CSF shunting. A total of 76 shunt-treated hydrocephalic children were examined at least once between two and 12-years after surgery to determine what skull changes had occurred and to assess the children's intellectual status. The high incidence of skull changes in shunt-treated, non-tumoral, hydrocephalic children was confirmed. A strict relationship existed between skull changes and low intracranial pressure. The results indicate that impairment of mental development parallels the degree of skull changes, suggesting a close relationship between impaired mental development and cerebrospinal fluid hypotension.


Isolation and characterization of high and low differentiation-inducible Friend leukemia lines. Induction of erythrodifferentiation was carried out by addition of dimenthyl sulfoxide or butyric acid to the culture medium among 80 subclones of T-3-Cl-2 Friend mouse leukemia line. Hemoglobin-positive cells were counted on day 5 of the inducer treatment on the hemocytometer after benzidine staining. Some cell lines were indicible by both of the inducers, but others were insensitive to dimethyl sulfoxide, but sensitive to butyric acid. Eight characteristic T-3-Cl-2 subclones have been selected; 2 highly inducible, 2 moderately inducible, and 4 minimally inducible. The data of differentiation inducibility together with the history of the T-3-Cl-2 line may facilitate extensive application of the T-3-Cl-2 system.


Experimental enzyme replacement in genetic and other disorders. To correct a genetic defect, it would not be enough, say, to inject the missing enzyme, since the body's immune defenses would rapidly destroy it. A "Trojan horse" is needed to evade immune surveillance. The evolution of such an approach is described, as well as how it has been used to "cure" Tay-Sachs disease in culture, utilizing immunoglobulin-disguised liposomes to bring hexosaminidase A to deficient cells.


Fibrosarcoma of bone. A demographic, clinical and histopathological study of all cases recorded in the Swedish cancer registry from 1958 to 1968. The clinical records, radiographs and histopathological material of all forty-one patients recorded as suffering from fibrosarcoma of bone in the Swedish Cancer Registry for the years 1958 to 1968 have been analysed; in addition, four cases were found on histological review of a series of osteosarcomas. From this re-examination, twenty-four patients with genuine fibrosarcoma of bone were identified; twenty-two had primary neoplasms and two secondary. No sex or geographical differences were found. The tumours showed a prevalence for patients in the adult and older age groups. Half of the tumours arose from femoral or tibial metaphysial bone adjacent to a knee joint. All the tumours were of the medullary type. Almost one-third presented with a pathological fracture, and soft-tissue extension had occurred in all but three tumours. In contrast to previous reports, these tumours were more malignant than osteosarcomas and showed a five-year survival rate of only 4-2 per cent. In accessible sites, ablative surgery was used as the primary treatment, Fibrosarcoma of bone is a distinctive lesion and should be distinguished carefully from periosteal and soft-tissue fibrosarcomas because of differences in prognosis and treatment.


Metastatic spread of fibrosarcoma of bone; A report on forty-nine cases, and a comparison with osteosarcoma. Of tumours arising in otherwise normal bones, fibrosarcoma is about one-third as common as osteosarcoma and may have a very slightly better prognosis. A comparison of the aetiology and behaviour of forty-nine fibrosarcomata and 152 osteosarcomata indicates several similar features. Fibrosarcoma lacks the characteristic peak incidence in adolescence of osteosarcoma, but the age and sex distributions of both tumour types in patients of middle life--twenty-five to sixty-five years--are remarkably similar, even in their frequency. With fibrosarcoma, perhaps, lung metastases are fewer and appear later, thus contributing to the slightly better survival, but there is some increase in the proportion of extra-pulmonary secondaries. As with osteosarcoma, patients with fibrosarcoma show some increase in the length of post-metastatic survival when metastases are of later appearance. For the whole series the five-year crude survival rate was 21 per cent, better results being recorded for patients with histologically well differentiated tumours (30 per cent) and for long bone tumours when the patient was metastasis-free initially and the tumour was treated by prompt ablation (40 per cent). These are probably the best results one may expect for osseous fibrosarcoma without recourse to adjuvant antimetastatic therapy. Complete control of the primary tumour is likewise mandatory, and can be assured only by complete surgical removal when this is technically feasible.


Wholebody autoradiography: a beta-radioluminescence method for detecting tritium. A method of increasing the sensitivity of X-ray film for the wholebody autoradiography of tritiated compounds is described. Thirty micrometre sections are sprayed with a scintillator, Diphenyl oxazole (PPO) and exposed to light sensitive (screen) X-ray film at -70 degrees C. The method permits a substantial reduction in the required dose of tritium and of the period of exposure of tissue sections.


A standard field area frame for use in automatic image analysis. Thin, copper electroformed microcomponents have been used to provide standard field area frames for comparative cell counting techniques using automatic image analysis. The design of the frames and the technique for using them is outlined.


Nutrition of elderly men living alone. I. Intakes of energy and nutrients. The energy and nutrient intakes of 35 men aged 70 years and over, living alone at home, were studied using five-day records. The mean energy intake was 1628 (SD 545) kcal/day. Protein and calcium intakes were generally adequate, but 60% of the old men took less than 10mg of iron per day. Intakes of vitamin C were below 15 mg/day in 34%. Thirty-four percent took less than 0.8 mg thiamine daily. Intakes of vitamin A and riboflavin were, in general, adequate, except for a small number of subjects. It is concluded that about one-third of the men had deficient vitamin C or thiamine intakes.


Anorexia nervosa: a study of 44 strictly defined cases. Forty-four patients with strictly defined anorexia nervosa were studied. They were found to come from the higher socio-economic levels and to be the early born of older parents. Their families were of average size, but females were over-represented. Premorbid obesity was uncommon, but over two-thirds had secondary depression. The treatment methods used until 1974 showed no great variation in success. Poor prognosis was most commonly linked to use of purgatives. A new treatment programme involving re-feeding to reach ideal weight and followed by psychotherapy shows encouraging results.


Acute nephritis: a local epidemic.

Acute nephritis: a local epidemic. A dramatic increase in the incidence and severity of actue glomerulonephritis in the childhood population of Tauranga is report. The clinical features of the disease and streptococcal aetiology are discussed.


Lymecycline (Tetralysal) in the management of non-specific urethritis. One thousand and sixty patients with non-specific urethritis were treated with lymecycline (Tetralysal). An initial course of 600mg 12-hourly for one week was successful in 90.5% of cases, while 2% responded to a further course of 300mg 12-hourly for three weeks.


[Spino-thalamic cordotomy in cancerous pain. Results of a series of 124 patients operated on by the direct posterior approach]. The authors -- about a series of 124 cancerous patients treated during the 12 last years with open spino-thalamic cordotomy for intractable pain -- have tried to evaluate effectiveness of the operation with regard to its levels in relation to the site of pain. Patients suffering median or bilateral perineo-pelvic pain, isolated or associated with algias in one or both legs (group I: 50%) underwent a bilateral C8-C6 cordotomy in one stage. Patients with the same perineo-pelvic cancers but suffering only unilateral pain (group II : 31,8%) and patients with painful cancers in the leg (group III : 3,2%), were operated on with a C7 controlateral cordotomy. Patients suffering widespread unilateral pain in the chest, isolated or associated with algias in the arm, for instance from lung or breast cancers (group IV : 15%) underwent a controlateral C2 cordotomy. There was 3,2% mortality and one paraplegia. A useful early effect(i.e. complete or partial relief) was obtained : in 85% cases (60% and 25%) for the 1st group, in only 51% (36% and 15%) for the 2nd, and in 87% (56% and 31%) for the 4th. Relief was complete in each of the 4 cases of the 3rd group. In the 2nd group 39% of patients were completely relieved of their initial unilateral pain, but complained of an early post-operative pain on the other side. This secondary pain was supposed existing prior to the operation, but masked because of its lesser intensity. The useful results at the time of death, after a 6 month mean survival (from 1 month to 4 years), were 63,75% in the 1st group, 33% in the 2nd, 100% in the 3rd and 72% in the 4th. The high rate of poor results with unilateral cervical cordotomy in the perineo-pelvic cancers with apparently unilateral pain, led us since then to systematically perform for them a bilateral cordotomy. Thus, our general management for pain of malignant origin is now as follows: C8-C6 bilateral cordotomy for all the perineo-pelvic cancers whatever uni- or bilateral the site of pain may be; C7 controlateral cordotomy for the painful cancers of the leg; and C2 controlateral cordotomy for hemithoracic and/or arm pain, when related to very extended lung or breast cancers. We prefer complete posterior rhizotomy for limited cancers of the thoracic wall, and selective posterior rhizotomy through the scope, from -- the brachial plexus roots down to T4 -- for pain as from the PANCOAST-TOBIAS syndromes, or in case of painful involvements of the upper limb roots. For cervico-facial cancers we generally use combined sections of the sensory cranial nerves in the posterior fossa and of the cervical posterior roots.


Nutrition of elderly men living alone. Part 2, Vitamin C and thiamine status. A dietary survey using the five day record method was carried out on 35 elderly men living alone in the Christchurch area. The mean calculated intake of vitamin C for these men was 31 mg/day. These dietary intakes of vitamin C were significantly correlated with both plasma vitamin C levels and with leucocyte vitamin C levels. Twelve men (34 percent) with lowered dietary intakes of vitamin C were in the range for asymptomatic scurvy. The mean calculated intake of thiamine was 1.05 mg/day. The mean TPP effect was 12.9 percent (n = 27). Dietary intakes of thiamine showed a significant inverse relationship with TPP effect. Eight subjects (23 percent) who too, less than the Australian dietary allowance had an elevated TPP effect. By both dietary and biochemical methods there was evidence of subclinical vitamin C and thiamine deficiencies in more than a quarter of these men.


Evaluation of the airflowmeter in the assessment of airways obstruction. The airflowmeter, a new inexpensive instrument measuring severity of airways obstruction in arbitrary units, was found to correlate well with standard respiratory function tests, and to be more sensitive than FEV1 in detecting changes in obstruction. Despite the distortion of maximal expiratory flow-volume relationship induced by the resistance of the meter, and the considerable variability between instruments, the airflowmeter should prove useful for regular monitoring of patients with variable airways obstruction.


Bacterial meningitis: a review of 53 patients. The mortality figures and incidence of bacterial meningitis in children from Tauranga are reviewed. The high rate of meningitis in relationship to overseas countries is discussed.


Abdominal tuberculosis in Kathmandu, Nepal. Twenty-five cases of abdominal tuberculosis treated in Kathmandu, Nepal are presented. The clinical features, diagnostic investigations, surgical treatment and pathology are discussed and the literature on abdominal tuberculosis, with special reference to developing countries, is reviewed.


Neurological sequelae after lithium intoxication. Severe lithium intoxication was seen in a 57-year-old woman despite close monitoring of blood lithium levels over 23 months. High blood lithium levels were aggravated by drug induced hyponatremia. Neurological sequelae were still present six months after admission,


Ectopic ureter in the female causing incontinence. A case of urinary incontinence is presented in a 12-year-old girl, illustrating the clinical and radiological difficulties in reaching the correct diagnosis.


Cancer chemotherapy: drug combination and multiple modality treatment. Research has provided many antitumour agents which show varying degrees of effectness against both experimental animal and human cancers. Successful selection of drugs for use in combination can increase antitumour effectiveness. Combination toxicity indices can assist in selecting potentially useful drug combinations. As a result of the first-order kinetics of drug induced tumour cell kill, ability to cure by chemotherapy is inversely related to the size of the tumour population. For chemotherapeutic cure of advanced relatively drug-resistant cancers (animal or human) with existing drugs, there must be prior reduction of tumour burden by alternative treatment methods. In such cases the correct target for present agents is the metastases remaining after noncurative surgery and/or radiotherapy.


Colonoscopy: a new diagnostic and therapeutic technique. Since January 1974, 150 colonoscopies have been performed. The method is reviewed and indications for diagnosis or therapy are outlined and examples illustrating these indications are given. It has proved to be an excellent diagnostic and therapeutic technique.


The practice nurse.

The practice nurse. This is a review of one year of operation of the practice nurse scheme immediately following the introduction of a subsidy for practice nurses in urban practices. The versatility and competence of the nurse is illustrated. The contribution of the nurse to prevention, surveillance and practice efficiency is emphasised.


Transient hyperthyroidism complicating hydatidiform mole. A 15-week pregnant patient with hydatidiform mole presented with overt features of hyperthyroidism. With evacuation of the uterus and subsequently hysterectomy, her thyroid state returned to normal. The transient nature of the syndrome makes definitive anti-thyroid treatment unnecessary.


The angle of obesity: a simple measurement for body typing. Measurements of the angle at the xiphisternal notch was taken in 143 school children between the ages of six and fifteen years, the average being eight. The children were graded as thin (T), normal with a tendency to be thin (NT), normal (N), normal tending to be fat (NF), and fat (F). This trading was by visual assessment. The average angle was found to be 90 degrees. Those with lesser than the average angle tended to be thin and those with greater than the average angle tended to be fat. The smaller angled were considered to have a larger thorax and smaller abdomen and vice versa for the larger angled children. The significance of these findings to various diseases is discussed and the significance of measuring this angle.


Attitudes of the public to medical care: Part 7. Specialist services. A sample of the adult population in Auckland and Dunedin was surveyed with regard to their utilisation of an opinions about private specialist services. Generally the utilisation of such services was high: almost half the respondents had either had a member of their family utilise the services of a specialist or had utilised such services themselves in the previous five years. The number of services for one patient for one consulting cause showed "specialists" were acting as such rather than as consultants. Not all such services were initiated through a general practitioner. Slightly more respondents would choose a private specialist rather than a hosptial specialist if their general practitioner considered a specialist opinion necessary and about one quarter of respondents had no preference: the reason for such a choice being made are described. There was considerable misinformation and lack of knowledge concerning the financing of such services.


A case of self-induced digoxin poisoning: with His bundle studies of the site of heart block. A case of digoxin overdose was described. Despite vigorous gastric lavage, the serum digoxin which was 0.8 ng/ml on admission rose to 7 ng/ml four hours later. The main side-effects were symptoms of nausea and anorexia and conduction defects including complete atrioventricular dissociation requiring pacemaker insertion. Opportunity was taken to study the site of heart block with His bundle electrography during the conduction disturbances. This showed that the site of block was situated above the His-Purkinje system in the atrioventricular (A-V) node.


[Cranial irradiation in acute lymphoblastic leukaemia (author's transl)]. Recent literature is reviewed an 48 personal cases of cranial irradiation in treating acute lymphoblastic leukaemia in infancy are reported.


[Problems posed by loss of cheek tissue on a tumorous terrain]. The authors describe the case of a patient with right retrocommissural lesion treated by iridiumtherapy and an enormous orostoma which appeared three years later. Radiography showing a metallic opacity caused hesitation for some time between diagnosis of radionecrosis and a recurrence. Treatment called for extensive excision of the cheek. Satisfactory cover was obtained by means of a broad lingual flap for the deeper layers and by a cervical flap for the superficial layers.


[Hereditary enamel dysplasia. Therapeutic approach apropos of 2 cases]. Two cases of hereditary dysplasia in the same generation of a family are presented. The genetic line is suggestive of a dominant transmission. The therapeutic attitude in each case: --Orthodontic, endodontic and prosthetic rehabilitation in the 1st case. At the patient's strong urging, a total fixed denture was made, which made it possible to correct moderate protrusion of the incisors and to obtain the aesthetic result desired by the patient. This work was carried out in the Stomatological Clinic of Lyon, by students working for their specialty certificate in stomatology. --In the case of the younger sister, the presence of a markde skeletal open-bite and the refusal of any surgical solution led to the total extractions requested by the patient. A mobile denture was made by her own dentist. Thus complete assessment and knowledge of the patient's precise wishes make it possible to adopt the most desirable therapeutic approach in each case.


[Several cases using a Kirschner nail in the treatment of low subcondylar fractures of the mandible]. The authors report four cases of low sub-condylar fractures of the mandible treated surgically. In three cases fixation was obtained using a transfocal Kirschner nail. They then describe the operative technique with its difficulties and the indications for transfocal nailing.


[Mandibular synthesis. Placement of the synthesis as a function of mandibular stress]. After recalling Michelet's principles of mandibular osteosynthesis, the authors relate their experiences after 18 months of biomechanical analysis. They define the best locations for osteosyntheses according to calculations of when flexion and torsion occur, taking anatomical conditions into account. Details are given of the position of the plate or plates according to the location of the fracture or osteotomy (horizontal branch, symphysal and para-symphysal region and angle). Analysis of stresses within the osteosynthesized mandible has resulted in the development of what seems to be a reliable medium. One hundred anf forty facial osteosyntheses they have carried out confirm their faith in the safety of the method.


[Non-surgical treatment of tuberous angiomas of the lip. Apropos of 26 cases]. Among the various methods that can be used for the treatment of hemangiomas of the face, the use of Yttrium 90 radium needles seems to give the most satisfactory esthetic results. One application is usually sufficient to obtain disappearance of the tumor. Spontaneous regression is now a generally accepted fact, however, and the essential problem remains whether hamangiomas should be treated all when no complications are present.


[Multiple cancers of the oral cavity. An unusual association of an epidermoid carcinoma of the mucosa with a bone carcinoma of salivary origin]. Multiple cancers cannot be considered as accidentally discovered curiosities. They have their own characteristics and differ from multifocal cancers or those secondary to a primary cancer. The authors describe the rare case of a patient suffering from two different types of cancer of the oral cavity; the first one was an epidermoid carcinoma of the upper alveolar mucosa, the second a salivary carcinoma of both epidermoid and glandular type situated within the bone of the mandible. A comparative study was carried out on the muco-epidermoid tumour and the adenosquamous carcinoma which proved the separate indentity of the second cancer. The galloping development of the adenosquamous carcinoma raises the problem of the effect of the primary cancer on the development of the second.


Chronic myelocytic leukemia: cytogenetic findings and their relations to pathogenesis and clinic. The chromosome constitution of myeloid cells of 106 patients with chronic myelocytic leukemia (CML) was studied. Two thirds of the patients were in the chronic and one third in the blastic phase. Particular attention was paid to patients with a mixture of Ph1-positive and Ph1-negative metaphases, and those with additional chromosome anomalies. A statistical analysis of the additional anomalies observed during the chronic and the blastic phase waandom involvement of certain chromosome groups. Chromosomal findings in medullary and extramedullary tissues were compared; the results suggest an accumulation of cells with additional anomalies in extramedullary sites. Ph1-negative patients were shown to be older and to have a survival shorter than Ph1-positive patients. The medium survival time of patients in the blastic phase may be longer in those without additional chromosome anomalies. Apart from the chromosomal status, hemoglobin concentration, the number of platelets and the percentage of myeloblasts in the bone marrow had a definite influence on survival times.


Physical assessment of 30 chronic cannabis users and 30 matched controls. Ganja is used extensively in the working-class population of Jamaica, particularly in certain agricultural and fishing communities. Ganja, smoking is illegal but can be accepted as part of the culture in these areas. Sixty male subjects were chosen for assessment, 30 chronic smokers and 30 controls from comparable social, economic, and cultural backgrounds, and were matched for height and age. A chronic smoker had somked a minimum of three spliffs per day for a minimum of 10 years. The subjects were admitted to the hospital for 1 week for psychologic and physical assessment. The physical assessment included a detailed medical history and examination, heart and lung radiography, electrocardiograms, respiratory, liver, and renal function tests, hematology, treponemal serology, and chromosomal studies. No significant physical abnormalities were found, except in two smokers, and there was no reason to suspect that these disabilities were related to ganja. No significant differences between the two groups were demonstrated in the wide range of tests administered.


The 94-day cannabis study.

The 94-day cannabis study. The UCLA cannabis project has provided several interesting observations that contribute to our knowledge about this plant and its constituents. Some of the findings (reduction in intraocular pressure, bronchodilation) may have therapeutic significance in the future. Certain results (testosterone lowering, airway narrowing after heavy use) indicate that side effects are also a possibility. Other data (unchanged immune response, lack of chromosomal alterations) seem to controvert the reports of other investigators. Still other information obtained (hemispheric lateralization, electroencephalographic changes) appears to represent new knowledge about the effects of cannabis on humans.


Neuropsychologic, intellectual, and personality correlates of chronic marijuana use in native Costa Ricans. The present cross-cultural study investigated the effects of chronic marijuana usage on higher adaptive brain functions and personality in native Costa Ricans. After extensive standardization in Costa Rica, a battery of neuropsychologic, intelligence, and personality tests was administered to two carefully matched groups of marijuana users and controls (NU = NC = 41). Multivariate analyses of multiple combinations of variables, followed by separate univariate tests on each measure, revealed essentially no significant differences between users and nonusers on any of the neuropsychologic, intelligence, or personality tests. Furthermore, no relationship was found between level of daily use (high vs low) and test performance. These findings were discussed in terms of previous chronic and acute studies of changes in adaptive brain functions and personality as a function of marijuana intake.


Differential association between chronic cannabis use and brain function deficits. To summarize, 12 objective tests that generated 16 test variables were administered to 850 male regular cannabis users and 839 nonusers. The tests were designed to assess various modalities, including speed of psychomotor performance, distance estimation, time estimation, immediate memory, and visuomotor coordination. Most of the test variables differentiated significantly between consumers and controls. At the same time, a significant second-order interaction emerged in most cases. This interaction meant that, under certain conditions that relate to the two dimensions "literacy-illiteracy" and/or "urbanism-ruralism," the superiority of controls over cannabis users became impressive, whereas under other conditions it almost disappeared. To account for this complex pattern of results, a working hypothesis was presented to the effect that "other conditions being equal, the lower the nondrug  level of proficiency on tests of cognitive and psychomotor performance the smaller the size of function deficit associated with drug usage." For an empirical examination of the hypothesis, six predictions were formulated. Three predictions defined specific relationships between level of performance, on one hand, and each of three organismic variables, on the other: literacy, urbanism, and age. The remaining predictions delineated relationships to be expected between size of function deficit and the three organismic variables. All our predictions were confirmed, showing less function impairment to be contingent with cannabis usage among the illiterates, rurals, and older subjects. Level of cortical arousal was suggested as the central process associated with the three organismic variables. Because the version of our working hypothesis was formulated with reference to chronic material, the possibility of a transposition of the paradign to research on the acute effects of the drug was discussed. The suggestion was made that our working hypothesis, in either version, is capable of establishing genuine integration between reports that present conflicting results on possible function deficits contingent with cannabis consumption.


Effects of acute and chronic inhalation of hashish, marijuana, and delta 9-tetrahydrocannabinol on brain electrical activity in man: evidence for tissue tolerance. An EEG profile for cannabis preparations equated for delta 9-THC activity has been defined in occasional cannabis users in New York and in long-term, high-dose hashish users in Athens. The EEG effects of enhanced alpha activity, decreased beta activity, and decreased mean frequency are dose dependent, both in intensity and in duration. The behavioral measures, particularly self-ratings of euphoria ("high" or "mastura") and heart rate, are also dose dependent and interrelated with the EEG measures. Tolerance to the cerebral, heart rate, and behavioral effects of repeated inhalations of delta 9-THC are demonstrable in chronic users and also in short-term (21-day) experimental administration studies. delta9-THC and cannabis preparations are distinguishable from opiates, hallucinogens, and deliriants by their EEG effects. No differences in incidence of abnormal EEG records were found between long-term heavy hashish users and controls. Taken in conjunction with the neurologic, echo-EEG, and psychopathologic data in these men, we failed to define a syndrome of persistent brain damage as a result of hashish use, although persistent adaptational changes are noted in the development of tissue tolerance.


Role of cannabis in psychiatric disturbance. Clinical observation suggests that cannabis is implicated in some types of psychiatric disturbance. A record of admissions to two urban and four rural hospitals in Jamaica is examined along with details of individual cases. One-third of male admissions to the psychiatric hospital have used cannabis. Of 74 males admitted to another psychiatric service over a 12-month period, 29 had used cannabis. Ten of these patients were diagnosed as "ganja psychosis," and four others were classified as "marijuana-modified mania." At another psychiatric service, 54 of 223 admissions (24.2%) for functional psychosis presented with cannabis usage as a comtributory factor. These 54 patients included 14 and seven cases of hypomanic and depressive reactions, respectively. At three other rural general hospitals, psychiatric admissions for psychosis showed 11 of 51, seven of 18, and 39 of 75 patients, respectively, in whom cannabis was considered directly responsible. These findings lend support to the idea of causation of illness or modification of existing illness. The negative findings of controlled studies in the same country are not inconsistent. A  suggested classification for adverse reactions to cannabis offered by one author is recommended, because it is in accord with common local clinical experience.