Disturbance in rhythm in 2 patients with a permanent pacemaker and two endocardial electrodes. Rhythm disturbances are described in 2 patients with an implanted permanent pacemaker. Both patients had nonfunctioning electrodes retained after previous complications. It was possible to observe, in both patients, during fluoroscopic examination that the electrodes occasionally touched each other. The etiology of the rhythm disturbances are discussed on the basis of the technical specifications of the pace makers. The interpretation of rhythm disturbances in patients with implanted pacemakers presents special problems. Disturbances in rhythm can be spontaneous and have no relation to, but possibly modified, by the implanted pacemaker. However, the rhythm disturbances can also result from the technical specifications of the implanted pacemaker or from defects in the same. The following case histories disturbances in rhythm in two patients, who both had 2 endocardial electrodes of which only one was connected to the implanted pacemaker.


Interference with cardiac pacemaker function. A survey is given of the factors affecting cardiac pacemaker function. Whereas it was earlier considered that external interference was a frequent cause of a pacemaker failure, more recent studies indicate that this is of minor importance. It would appear that failure of pacemaker function due to changes in the QRS-complex, i.e. voltage change, intraventricular conduction defects and frequency changes, intraventricular conduction defects and frequency changes, are more important. A lesser known cause of failure in demand function is the inhibition which arises from skeletal muscle postentials. This appears to be a major problem in some types of pacemaker. Manufacturing defects are unavoidable, and it can still be assumed that electronic component defects may develop in 1 of 1000 pulse generators. Cases with the problem of early run-away pacemaker are still being reported and two such cases are discussed. In one of the patients the run-away phenomenon was intermittent, and was accompanied by a variation in run-away frequency. This possibility should thus always be taken into consideration in a pacemaker patient presenting with snycope. In a patient with a QRS-inhibited pacemaker a double stimulation phenomanen has been observed.


Myelotoxicity of vincristine-prednisone therapy in treatment of chronic myelogenous leukemia in blastic transformation. Therapy with vincristine and prednisone (VP) has produced remissions in 30% of patients with chronic myelogenous leukemia in blast transformation (CML-BT). The possibility that therapy with VP can adversely affect the production of mature granulocytes in this setting has not been appreciated, as these drugs are generally considered free of myelotoxicity. In this report we review eight courses of VP administered to three patients with CML-BT. Granulocytopenia developed following all five courses in which granulocyte counts were normal prior to therapy; granulocytopenia worsened in two of three courses in patients who were granulocytopenic prior to therapy. Progressive leukemia in the marrow was excluded as a cause of granulocytopenia. It is important to recognize that VP therapy rather than disease progression may be a cause of granulocytopenia in CML-BT.


Significance of macrorheology and microrheology in atherogenesis. Atheromatous lesions represent a disturbance of homeostasis in the arterial wall, where the rates of uptake and production of atherogenic materials exceed the rates of egress and metabolic removal. The pressure and flow in the arterial system generate circumferential stress in the wall and shear stress on the wall. The magnitude and distribution of these stresses are affected by local vascular geometry and microrheologic behavior of blood. Circumferential stress is borne primarily by the media and adventitia, and shear stress has a greater influence on the endothelial cells, which form the principal barrier to transport of macromolecules into the arterial wall. Shear stress, turbulence, and longitudinal stretch cause an increase of macromolecular uptake by arterial wall, especially when the mechanical disturbances are periodic. These effects may be explained by an enhanced diffusion of plasmalemmal vesicles in the endothelial cells. Such short-term effects of rheologic factors should be considered together with their long-term influences on the structure and function of the arterial wall in order to elucidate the role of rheology in atherogenesis.


Conditions of flow at interfaces with flexible walls. It is shown that the presence of highly deformable surface layers of low elastic modulus produce effects in flow that tend to reduce throughout. This phenomenon seems to be due to the generation of surface waves and a corresponding fluid zone into which these waves are also partially propagated. Experiments are summarized that are consistent with this point of view. The implications for arterial and other blood flow are discussed.


Metabolic influences in experimental thrombosis. Studies presented in this report demonstrate that intravascular coagulation and thrombosis in the whole animal can be greatly influenced by noncoagulation factors, such as metabolic, endocrinologic, and nutritional states. Injection of a partially purified human serum procoagulant fraction produced no significant clotting abnormalities in normal fed rats; however, injection of an identical preparation in fasted, diabetic, and obese rats produced hypercoagulability of blood, thrombosis, and hemorrhage. Glucose injection in fasted rats and insulin injection in diabetic rats reversed their susceptibility to thrombosis. The concentrations of serum free fatty acids were shown to be elevated in the susceptible animals; however, they returned to normal in fasted and diabetic rats after injections of glucose and insulin, respectively. Infusion of free fatty acid-albumin preparations in normal fed rats rendered the animals susceptible to thrombosis when challenged with the serum procoagulant fraction.


Bone marrow: its contribution to heme catabolism. Heme oxygenase (HO) and biliverdin reductase (BR), the two NADPH-dependent enzymes involved in the degradation of hemoglobin and its derivatives, were measured in bone marrow aspirates from 5 hematologically normal persons, 4 patients with chronic leucemia (CL), 11 patients with acute leucemia (AL), 8 patients with refractory sideroblastic anemia (RA), 7 patients with iron-deficiency anemia (IA), 5 patients with hemolytic anemia (HA), and 7 patients with secondary anemia (SA) to determine the enzymatic capacity of the bone marrow in different hematologic disorders for heme catabolism. HO activity in the bone marrow of normal persons was 0.42 +/- 0.28 (SD) nmoles bilirubin/10 mg protein/min; in CL, 2.15 +/- 1.34; in AL, 0.39 +/- 0.25; in RA, 0.58 +/- 0.37; in IA, 0.41 +/- 0.28; in HA, 2.56 +/- 1.40; and in SA, 1.72 +/- 1.06. BR activity, respectively, was in normal persons 8.7 +/- 2.4 (SD) nmoles bilirubin/10 mg protein/min; in CL, 13.6 +/- 9.1; in AL, 3.8 +/- 3.1 in RA, 5.1 +/- 2.7; in IA, 5.5 +/- 3.7; in HA, 17.0 +/- 7.2; and in SA, 10.5 +/- 4.2. On the basis of these findings it seems evident that both oxygenase and biliverdin reductase activities of the bone marrow are capable of adaptive regulation. The physiologic role of bone marrow in heme catabolism seems to be of significant importance.


[Phospho-hexo-isomerase deficiency].

[Phospho-hexo-isomerase deficiency]. Hematologic, genetic and biochemical data of two patients suffering from glucosephosphate isomerase deficiency are described. In one of them a generalized deficiency could be demonstrated. The molecular instability of the deficient enzyme results in early inactivation. Its consequences for carbohydrate metabolism are exposed. Besides a non-spherocytic hemolytic anemia, a hepatic glycogenosis could be observed. Our patients are compared to litterature.


Erythroid differentiation and the cell cycle: some implications from murine foetal and erythroleukemic cells. On the basis of observations with (1) erythropoietin induced erythroid differentiation of foetal mouse liver proerythroblasts and (2) chemically induced expression of the erythroid program in MELC, it appears that DNA replication plays a critical role in the transition to haemoglobin formation. Erythropoietin acts selectively on proerythroblasts to stimulate first housekeeping RNA species (rRNA, tRNA), then cell proliferation and differentiation. In erythro-leukemia cells expression of the erythroid program is induced by a variety of polar compounds. DNA synthesis appears requisite to this transition to haemoglobin formation, The molecular site of action of inducing compounds is not established but it is suggested that one critical effect is on the structure of chromatin which occurs during DNA replication and results in the transcription of the erythropoietic gene program.


Pelvic exenteration for advanced pelvic malignancies. Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality rate of 14% is acceptable, and a five-year survival rate of 20% has been achieved. The procedure has a definite role to play in the management of advanced but otherwise localized pelvic malignancies.


Traumatic retroperitoneal rupture of the duodenum. A report of six cases of retroperitoneal rupture of the duodenum is presented. A high index of suspicion is necessary to enable early diagnosis to be made and appropriate treatment carried out. Early treatment will prevent the extremely rare, but at present uniformly fatal complication of gas gangrene. Plain X-ray and Gastrografin studies may help to elucidate the situation in particular cases, but are no substitute for repeated careful abdominal examination. It is suggested that large doses of penicillin be employed where possible in the management of these cases, in addition to such antibiotic therapy as may be expected to be effective against the usual Gram-negative bowel flora.


Bile duct injuries from non-penetrating abdominal trauma in childhood. Bile duct injuries from non-penetrating abdominal trauma are uncommon, but when unrecognized cause serious morbidity and significant mortality. To elucidate the problem three cases encountered over a 15-year period in the Manchester Children's Hospitals are reported, together with a review of the literature.


The surgical treatment of congenital coronary to pulmonary artery fistula. Six patients with coronary to pulmonary artery fistula underwent surgical treatment between January 1973 and August 1975. All fistula terminated in the main pulmonary artery just distal to the pulmonary valve. Two patients had severe coronary artery disease associated with the fistula. In all patients, the fistula was over-sewn from within the pulmonary artery in addition to ligation to the fistulous vessel on the surface of the pulmonary artery or heart, cardiopulmonary bypass being employed. Two patients underwent concomitant aortocoronary artery saphenous vein bypass for occlusive coronary artery disease. Follow-up data revealed that three patients were free of symptoms and two were improved, while one was lost to follow-up.


Mesothelioma in an agricultural community of India: a clinicopathological study. Mesothelioma is an uncommon neoplastic condition. Its association with asbestos exposure is well established, but it occurs even in non-industrial workers, and naturally there must be some other factors in its aetiology than asbestos exposure. In this report, five patients with primary mesothelioma, all belonging to a rural agricultural community with no chance of any asbestos exposure, have been documented. There was one common interesting observation, in that all five patients were associated with sugar-cane farming or an allied trade. Whether this observation is coincidental or has any aetiological bearing on mesothelioma needs further investigation. Its histopathological features, symptomatology, diagnosis, and treatment are discussed, with a brief review of the literature.


Traumatic dislocation of the hip joint in children. Between 1949 and 1972, 24 children under the age of 16 years were admitted to Middlemore Hospital with traumatic dislocation of a hip. Half of these were between 12 and 15 years of age, and there was a predominance of boys in the ratio of 7:1. A survey of these children supports the view that the hip joint of a child becomes dislocated more readily than that of an adult.


Fracture of the odontoid process.

Fracture of the odontoid process. A review of 26 cases of odontoid fractures has been carried out. Late diagnosis and consequent delay in treatment were found to be important causes of non-union. Myelopathy in odontoid fractures is of two types. One type is that present immediately after injury, while the other is delayed. In treatment of long-standing cases, only fusion without posterior decompression should be done. If the latter procedure is carried out, it can produce medullospinal haematomyelia with respiratory arrest and tetraplegia. In the performance of atlanto-axial fusion, the technique of bone grafting and the use of thick wires need emphasis.


The treatment of priapism by cavernosospongiosal shunt: results of operation in five patients. The cavernosospongiosal shunt operation is an effective method of treatment of priapism. Experience with five cases has led the writers to suggest early operation, avoidance of needle aspiration and the use of steroids.


Post-cholecystectomy wound morbidity: the influence of electrosurgery. The wound morbidity patterns following elective cholecystectomy were reviewed in 235 patients. The method used to divide the musculo-aponeurotic layers of the abdominal wall did not influence the overall wound morbidity rate. There was, however, a disproportionate number of males with wound morbidity following an electrosurgical incision. The explanation may be related to the increased rectus muscle mass in males.


Giant intracranial epidermoid tumour: a singular pearl? The chronic benign course and occasional gigantic size of posterior fossa epidermoids are illustrated by a case report, and the features of these tumours are reviewed.


Urgent aortic valve replacement in disseminated gonococcaemia associated with sinus of Valsalva aneurysm and fistula formation. A patient with aortic valve disruption due to gonococcal endocarditis and associated with a sinus of Valsalva aneurysm and fistula into the right ventricle is described. The rarity of this combination of conditions and the place of surgery in their management are discussed.


Volvulus of the transverse colon: a postoperative complication of truncal vagotomy and gastrojejunostomy. An instance of volvulus of the transverse colon in the postoperative period following truncal vagotomy and anterior gastrojejunostomy is reported. The clinical features of volvulus of the transverse colon are sudden onset of abdominal colic, distension and vomiting. A plain X-ray film of the abdomen is diagnostic. Laparotomy is recommended, followed by untwisting alone, or untwisting and colostomy when the bowel is viable, or resection with a transverse  colostomy and mucous fistula as a first stage when the bowel is gangrenous.


Advanced intraabdominal pregnancy: case report with a brief review of the literature. We here present a case of advanced intraabdominal pregnancy diagnosed at laparotomy. A brief review of the literature is included, with special reference to the problems of diagnosis and of management of the placenta.


A prospective trial of povodone iodine solution in the prevention of wound sepsis. In a prospective blind trial in patients undergoing intraabdominal surgery, instillation of povodone iodine (PVI) solution into the wound failed to reduce the incidence of wound sepsis.


Systeme international d'unites (s.i. units). The metric system is now used in most countries for expressing measurements in the health care field. The original metric system based on lenght (centimetre), mass (gramme) and time (second) has proved inadequate. The International Bureau of Weights and Measures, which has the ultimate responsibility for standarization of measlring systems, has revised and extended the metric system, through a series of general conferences on weights and measures, to the systeme International d'Unites (S.I.). This is now the internationally accepted language for measurements throughout science and industry.


Quality control in the Part I F.R.A.C.S. examination. The conduct of College examinations has seemed a mystery to many candidates. Both candidates and supervisors of training have echoed this concern with the R.A.C.S. new Part 1 examination. This paper describes the work of the Board of Examiners of the Royal Australasian College of Surgeons and the procedures by which the new Part 1 examination is constructed, administered, analysed and refined. It sets out how the examination has been developed into an educational instrument to provide feedback to candidates, to teachers and to examiners, so that each can improve his performance. In addition, the Board has acquired data from each candidate on his learning opportunities, and from each candidate's mentor on various performance characteristics of the candidate.


An analysis of the results of the Part 1. Examination for the F.R.A.C.S. An analysis of the results of the candidates undertaking the Part 1 F.R.A.C.S. examination between February 1973 and February 1975 inclusive is presented. Particular attention is paid to those who failed the examination at the first attempt, and their subsequent progress has been related to their performance at this time. The analysis forms the basis for the information which is now given to unsuccessful candidates and their clinical supervisors.


[Long-term results of multiple sequential treatment (protocol HIM-T.S.M) of children with acute lymphoblastic leukemia]. The long-term results of treatment of 32 children with acute lymphocytic leukemia, treated with protocol HIM-TSM, are reported. Induction therapy with prednisone and vincristine, gave 94% of complete remissions. Only 25 patients were evaluable for the maintenance therapy study. They reveived two courses of cyclic intensive chemotherapy with seven drugs (methotrexate, 6-mercaptopurine, cyclophosphamide, prednisone, vincristine, intrathecal methotrexate and hydrocortine, daunomycin and citosine-arabinoside) at high doses and thereafter, cyclic MTX 6MP and CP and periodic VCR and Pred. Median duration of complete remission was 28 months and 40% of the patients had initial relapse in central nervous system (median time of presentation of CNS relapse was 25 months). On Feb., 1976, 56% of the children are alive but 24% of them have had at least one relapse and now, are again in remission. Eight cases (32%) have never relapsed, from 42 to 58 months after remission was obtained (median of 46 months) and they are now off any antileukemic therapy for 11 to 22 months (median of 16 months). These long-term results are compared with those obtained with a previously reported protocol (HIM-TMI). No significant progresses were seen in the Protocol HIM-TSM, but both studies showed very good results for this country. More intensive systemic chemotherapy and CNS prophylaxis are needed. This has been taken into account in a more recent study (Protocol HIM-06) and the preliminary results are encouraging. Fourteen patients from these studies and several other children, all of them with more than 42 months of continuous remission and off therapy, have in our experience, a high chance of being cured.


Chondrosarcoma of the mandibular condyle. Report of a case with special reference to radiographic features. A case of chondrosarcoma of the mandibular condyle is described. With carefully taken tomographs, a diagnosis of chondrosarcoma of the mandibular condyle can be made with some degree of certainty, on radiological evidence alone. Chondrosarcomata of the mandibular condyle may manifest with the typical symptoms of the temporomandibular joint dysfunction syndrome. Tumours of the condyle can reach a large size without producing clinically obvious swellings. The literature pertaining to chondrosarcoma of the mandibular condyle is reviewed.


Oral swelling in Sjögren's syndrome.

Oral swelling in Sjögren's syndrome. A case is reported of a 69-year-old female with Sjögren's syndrome who presented with a problem of interest to the oral surgeon. The clinical features and cryosurgical management of a rare cause of palatal swelling are described. The confusion that exists in the literature concerning the nomenclature of chronic inflammatory salivary gland lesions is discussed.


The CRST syndrome (calcinosis, Raynaud's phenomenon, sclerodactyly and telangiectasia). The CRST syndrome is defined, and its relation to systemic sclerosis described. The literature referring to the condition is reviewed and a further case reported. Clinical and diagnostic features of the telangiectasia are emphasised, particularly in comparison with those of the similar condition, hereditary haemorrhagic telangiectasia.


Sterilisation of teeth for homogenous transplantation. Sterilisation of teeth for homogenous transplantation has been successfully achieved by combined ultrasonic waves and immersion in 6 per cent hydrogen peroxide. This combined treatment was found to have no harmful effect on the tooth integrity as indicated by enamel solubility, hardness, root canal seal and tooth size and weight. It is suggested the method offers the possibility of storing teeth in a "tooth bank".


Surgical anatomy of the ascending ramus of the mandible. A study of identifying the position of the lingula of the mandible on the external surface is described. The study was undertaken in an attempt to avoid damage to the inferior dental neurovascular bundle during operative procedures on the ascending ramus.


Horner'sy syndrome and its significance in the management of head and neck trauma. The history, mechanism and aetiology of Horner'sy Syndrome is presented and the pharmacology of the pupil is discussed. The case reported is a rare combination of Horner's Syndrome in a patient who sustained bilateral fractures of the mandible and a chest injury. It is emphasised that the miotic changes in Horner's Syndrome, in combination with head injuries can lead to confusion in diagnosis and the potential anaesthetic hazards and their influence on the management of the facial injury are outlined.


Cortically induced masticatory rhythm and its modification by tonic peripheral inputs in immolbilized cats. Repetitive cortical stimulation induced rhythmical masticatory jaw movement and masseteric nerve activity in cats with the spinal cord sectioned at the C2 level. Jaw depression alone did not induce any rhythmical jaw movement, but it turned the irregular jaw movement evoked by subthreshold cortical stimulation into the regular jaw movement as evoked by suprathreshold cortical stimulation. The cortically induced rhythmical masseseteric nerve activity could be induced even in immobilized condition and after cerebellectomy, although the rhythmical nerve activity was depressed in amplitude and the rhythm became slower than before immobilization. Tonic jaw depression after immobilization facilitated the tonic activity in the masseteric nerve and also induced a remarkable increase in the amplitude of the cortically evoked rhythmical nerve activity and a slight acceleration of the rhythm, leading to the same masticatory rhythm as before immobilization. It was concluded (1) that the cortically induced masticatory rhythm in cats is basically generated centrally and (2) that the tonic inputs from the muscle spindle in the jaw-closing muscles participate in the rhythm formation by supplying tonic excitatory inputs mainly to the jaw-closer motoneuron and also to the central rhythm generator.


Histological studies on early changes of the hamster gingival epithelium by N-nitrosomethylurea. The effect of repeated intragastric administration of N-nitrosomethylurea on the molar gingival epithelium of the hamster was investigated both higtologically and histoautoradiographically. Thickening and downward proliferation of the gingival epithelium were evident from the second month of the treatment, in the attachment epithelium and interdental epithelium. Subsequently, the apical part of the crevicular epithelium, epithelium of the oral  aspect of the gingiva, and the marginal crevicular epithelium thickened. About three months after the beginning of the administration, thickening, hyperkeratosis, and downward proliferation of the gingival epithelium were widespreas and proliferated epithelial cell nests were parakeratotic, often assuming a structure of keratotic cyst, which invaded the periodontium, accompanied with compressive resorption of the alveolar bone and involvement of bone marrows. Cellular atypia appeared three months after the first treatment, occasionally suggesting early  malignancy. Epithelial proliferation was generally not accompanied with any distinct inflammatory change. In the autoradiographic analysis, it was clearly noticed that labeled cells had increased in each epithelial zone before the histological changes became evident- The results of the present experiment were discussed in reference to the pathogenesis of gingival carcinoma.


Aseptic bone necrosis in Japanese divers. Medical examination was performed on the divers in Ohura for 7 years from 1969 to 1972. Aseptic bone necrosis was found in 268 of 450 divers (59.5%). Men with over 5 years of experience in diving were highly affected (more than 54.4%). These bone lesions were found most frequently in the proximal end of the femur and the humerus. There was a significantly higher incidence of bone lesions in the men who dived over 30 meters. In the group of men with one or more bone lesions, 73.1% were known to have been treated for bends. The bone, once exposed to a certain compression of air, would have a tendency to develop bone lesions even after cessation of diving. Type A2 (linear opacity) led to the structural failure of the joint surface of the femur and the humerus. Histopathological study was carried out on the sections of bone obtained from three autopsy cases and four operated cases. Formation of air bubbles in the bone marrow cavity seemed to be the most important as the cause for the occurrence of aseptic bone necrosis, and local circulatory disturbance might be the most responsible for the progression of the bone lesion.


Cleavage lines in the facial skin of Japanese cadavers. Since Langer published his work on the cleavage lines of the skin in 1861, many Japanese and foreign authors have referred to Langer's lines as the most appropriate guides for skin incisions giving minimum scarring after heelings, but it has recently been suggested that the cleavage lines of Langer do not constitute a suitable guide for making an incision. Furthermore, comparison with directions of the lines described in the published textbooks has shown some discrepancies in detail among these descriptions, especially in the face. Therefore, Japanese cleavage lines were examined in the facial region of seven male and four female Japanese cadavers, and the following results were obtained. 1) Forehead: The long axes of the cleavage lines tend to run transversely as a whole. 2) Eyelids: The lines run, drawing a concentric loops, aroung the eye-fissures. 3) Lips: The main direction of the lines on the upper lip is radial upwardly, and the lines radiate downward on the lower lip.


The safety assessment in the dog of a charcoal haemoperfusion column. 1. The safety of a carbon haemoperfusion column, Haemocol, has been studies in beagle dogs. 2. only minor changes in physiology, haematology and plasma chemistry were detected, except those associated with an improvement in clinical status. 3. It is concluded that haemoperfusion through this column is a safe and simple procedure, which merits evaluation in the treatment of severe drug overdose in man.


The specificity of antisera for the radioimmunoassay of arginine-vasopressin in human plasma and urine during water loading and dehydration. 1. Rabbit antisera against arginine-vasopressin (AVP) were evaluated for sensitivity and specificity in a radioimmunoassay based on the extraction of AVP from plasma and urine on to Florisil. 2. Comparison of the immunoreactivity of AVP with analogues showed that one antiserum (R2) reacted principally with the hexapeptide ring and another (R4) bound to the tripeptide tail and was reactive with some reduction and hydrolytic products of the native peptide. 3. The minimum amount of AVP measurable in the radioimmunoassay was 1 pg. The extraction of AVP from plasma and urine gave a recovery of 93 per cent (sd 5 per cent). A plasma sample repeatedly assayed with R2 gave a value of 1.4 ng/1 (sd 0.2, n=12). 4. The antiserum specific for the hexapeptide ring (R2) showed that in normal subjects AVP concentration ranged from 3.2 +/- 2.52 ng/1 after dehydration to 0.16 +/- 0.1 ng/1 after water loading.


Diminished albumin binding of zinc in serum of pregnant women. 1. Distribution of zinc between the metalloprotein alpha 2-macroglobulin and albumin was determined in samples of serum obtained from twenty-three women in their third trimester of pregnancy and eighteen women who were not pregnant. 2. The decrease observed in total serum zinc in the group of pregnant women could be accounted for in large part by a decreased concentration of albumin-bound zinc. 3. The concentration of serum albumin was lower in the pregnant women, thus hypoalbuminaemia, which is often invoked to explain hypozincaemia in pathological situations, may in part account for hypozincaemia in pregnancy. 4. The affinity of albumin for zinc added to serum from pregnant women was less than that of albumin from non-pregnant women. This was determined by competition experiments between albumin and glycine for zinc. Decreased affinity of serum albumin for zinc may also contribute to the hypozincaemia associated with pregnancy.


Analytical subcellular fractionation of jejunal biopsy specimens: methodology and characterization of the organelles in normal tissue. 1. Portions of closed jejunal biopsies were gently homogenized in isotonic sucrose or sorbitol and centrifuged at 800 g for 10 min to prepare a cell extract. 2. The extract was fractionated in a single-step procedure by isopycnic centrifugation on a continuous sucrose or sorbitol density gradient with the Beaufay automatic zonal rotor. 3. The subcellular organelles were located in the density gradient by assay of marker enzymes and previously unassigned enzymes were localized to particular organelles. 4. The following organelles were characterized by their modal equilibrium densities in sucrose density gradients: brush borders (1.21), peroxisomes (1.18), mitochondria (1.16), endoplasmic reticulum (1.16), basal-lateral membranes (1.12). At least three distinct populations of lysosomes with different modal densities and enzyme content were demonstrated. 5. This analytical fraction technique can be used to study the subcellular pathology of human jejunum.


Regulation of breathing during exercise in normal subjects and in chronic lung disease. 1. The breathing pattern in normal subjects during exercise was compared with that in patients with obstructive and restrictive lung defects. 2. In most normal women and patients with obstructive or restrictive lung disease, as the frequency of breathing increased both inspiratory and expiratory duration fell. However, in most normal men (74 per cent) inspiratory duration did not fall as ventilation increased. 3. Women breathed faster than men, and both obstructed and restricted patients breathed faster than normal subjects. 4. The airflow patterns in normal men and women were similar, but most patients with restrictive or obstructive lung disease showed an approximately exponential fall in flow during expiration.


Distribution of blood flow in the hypothermic (27 degrees C) dog kidney. 1. Renal function was measured in seven normo thermic (38 degrees C) and seven hypothermic (27 degrees C) dogs. 2. The glomerular filtration rate was 60 per cent lower in the hypothermic animals, and the renal blood flow as 51 per cent lower. The intrarenal distribution of blood flow was measured by the uptake of 86Rb from the blood into different regions of the kidney. Hypothermia reduced flow by 34 per cent in the outer cortex, 72 per cent in the inner cortex, 61 per cent in the outer medulla and 69 per cent in the inner medulla. 3. Radioautography indicated a high blood flow to an area of the outer medulla of hypothermic kidneys, which may indicate medullary blood flow "shunting". 4. The results have been discussed in relation to a number of clinical and experimental observations.


Influence of severe potassium depletion and subsequent repletion with potassium on muscle electrolytes, metabolites and amino acids in man. 1. Two women with severe hypokalaemic alkalosis were investigated by means of muscle biopsy before and at the end of 2 and 3 weeks respectively of intense therapy with potassium chloride. 2. The muscle biopsy material was analysed for water, electrolytes, adenine nucleotides, phosphocreatine, free creatine, pyruvate, lactate, glycogen and free amino acids. The extra- and intra-cellular distribution of water, electrolytes and amino acids was calculated by the chloride method. 3. Both patients showed a marked loss of intracellular potassium and an increase in intracellular sodium concentration. The muscle magnesium content was also slightly decreased. After repletion with potassium chloride, muscle sodium and potassium became normal. 4. The contents of creatine phosphate, ATP, ADP, AMP, lactate and pyruvate were within normal limits, but the phosphocreatine/total creatine ratio was reduced. After repletion, a small change in the apparent creatine-phosphokinase equilibrium had occurred, suggesting a minor increase in intracellular pH. 5. The concentrations of the basic amino acids, lysine, arginine and ornithine were increased far above normal. The intracellular accumulation of arginine was much higher than the increase in lysine concentration and histidine concentration was normal. This differs from findings in potassium-depleted rats, where the intracellular lysine concentration is much higher than arginine concentration and histidine is high as well. After potassium repletion the intracellular concentration of ornithine, lysine and arginine became normal in one case and decreased considerable in the other. An increased intracellular concentration of glutamate and glutamine was also observed after potassium repletion.


The role of small intestine and kidney in bromosulphthalein conjugation. 1. The roles of the kidney and the small intestine in the conjugation of bromosulphthalein have been compared with that of the liver. 2. Studies with homogenates indicated that the liver has a higher bromosulphthalein-glutathione-conjugating activity than the intestine and kidney. The reduced glutathione content of the liver is greater than that of the small intestine and kidneys, which contain comparable amounts. 3. Experiments in vitro with tissue slices confirmed that the three organ are able to extract significant amount of bromosulphthalein. In carbon tetrachloride-induced hepatic necrosis the uptake and conjugation of the dye by the liver were reduced but were increased in the kidney and unchanged in the small intestine. 4. After an intravenous injection of bromosulphthalein, the percentages conjugated in the liver, kidney and gut were similar.


A competitive protein-binding assay for 25-hydroxyvitamin D. 1. We describe a modified competive protein-binding assay for 25-hydroxyvitamin D, which does not require the prior separation of vitamin D from 25-hydroxyvitamin D. 2. Bovine albumin was used in the buffer, at a concentration of 1mg/ml, as a protein stabilizer and lipid solubilizer. Bovine albumin from different manufactures produced very different non-specific binding of 25-(3H)hydroxycholecalciferol (ranging from 3.3 per cent to 58.9 per cent). 3. The mean concentration of 25-hydroxyvitamin D in sera from normal children in Johannesburg was 76.75 +/- 24.75 mumol/ml (30.7 +/- 9.9 ng/ml).


Self-paced walking as a method for exercise testing in elderly and young men. 1. An exercise test has been developed which is suitable for elderly or frail subjects. It is based on free walking at three different speeds on a level indoor course of 256m. The subject sets his own pace in accord with simple instructions. 2. Twenty-four elderly men and ten young men took part in the study. 3. The time and number of paces taken to cover two sections of 100m within the course were used to establish that the subjects walked steadily. Walking speed, pace frequency and stride length were then calculated. 4. Heart rate was obtained with body-borne tape recorders and related to the walking speed. The heart rate at a standard walking speed could then be obtained by interpolation. This is an assessment of the cardiovascular response to exercise (physical condition). The variation on repeating the test was +/-5 per cent and there was no significant difference between the two age groups. 5. The assessment was found to correlate moderately well with a conventional assessment of physical condition based on oxygen uptake from tests on a bicycle ergometer. 6. The test could also be used as a performance index since walking speed was characteristic for the subject. The younger group walked significantly faster than the older group. As a performance index the test is therefor sensitive to age differences.


Erythroid cell differentiation.

Erythroid cell differentiation. We have reviewed erythroid cell differentiation from two points of view: 1) differences between fetal and adult human red cells with particular reference to alterations which can occur in the normal pattern of erythroid cell development during the course of leukemia; 2) beochemical events which occur during erythroid cell maturation, as a model system for the study of the control of gene expression. During the course of many leukemias there is the synthesis of red cells containing fetal hemoglobin. In most cases this phenomenon is limited to a small population or clone of red cells and probably represents a nonspecific response of the bone marrow to a hematologic stress. However, in juvenile chronic myeloid leukemia and, in rare cases of erythroleukemia, there is a major reversion to fetal erythropoiesis, with progressive increase in fetal hemoglobin levels and synthesis of red cells which contain not only fetal hemoglobin but have a true fetal pattern of protein synthesis affecting proteins other than Hb F, namely Hb A2, carbonic anhydrase and the membrane antigens i and I. In this case, the fetal erythropoiesis may be a more specific manifestation of the leukemic process and may be related to the phenomenon of fetal protein synthesis (alpha-fetoprotein of carcinoembryonic antigen) observed in other types of neoplasia. Further information on the etiology and pathogenesis of abnormal cell proliferation and differentiation in the leukemias can be obtained by the study of experimental systems permitting the investigation of the regulation of gene expression in differentiating mammalian cells. Maturing erythroid cells provide a promising system for such investigations for many reasons: differentiating erythroid cells can be obtained relatively free of other cell types; a large amount of a well characterized product, hemoglobin, is synthesized; techniques are now available that permit isolation of erythroid precursors at different stages of differentiation (5-8); and finally, highly sensitive methods of measuring globin mRNA levels by DNA-RNA hybridization are currently available (13, 26, 27). We have used such techniques to measure levels of globin mRNA in separated populations of murine erythroid cells at different stages of maturation. These studies demonstrated a correlation between globin mRNA content and degree of morphological maturation. In the least well differentiated cells, however, there appeared to be a disproportionate amount of mRNA for the level of hemoglobin synthesis in these cells. These results suggest the presence of some translational control of globin mRNA in the early stages of erythroid development, although the major control of globin gene expression in this system seems to be at the transcriptional level...


Proliferative behavior of hemopoietic cells in preleukemia and overt leukemia observed in one patient. Hemopoietic cell proliferation was studied in a patient suffering from preleukemia characterized by peripheral pancytopenia and hypercellular bone marrow with ineffective erythropoiesis. Two years later when overt acute myelogenous leukemia had developed the study was repeated. The kinetics of proliferation were investigated by a new method which allows evaluation of the rate and time of DNA synthesis in individual morphologically defined cells. Erythropoiesis was found ineffective to the same degree in both stages of disease. The rate of erythroid cell proliferation, however, was reduced in overt leukemia only. The myeloid system showed a grossly reduced production rate of myeloblasts in preleukemia whilst the same parameter was strongly increased in leukemia. This high production rate of myeloblasts in overt leukemia was interpreted as indication of a far-reaching self-maintenance of the myeloblast pool in this stage of disease. The proliferative activity of the individual myeloblasts was reduced already in preleukemia, and even more so in leukemia. In order to explain the amplification of the myeloblast pool with the onset of overt leukemia a change in the mode of myeloblast divisions is assumed. For this a transition from steady state to some degree of exponential growth gives the most plausible explanation.


Leukemic anaplasias reflecting physiologic cytogenesis of myeloid system. Naphthol AS-D chloroacetatesterase activity in peripheral blood granulocytes is confined to neutrophils which are all positive and to a minor part of monocytes. Its occurance in eosinophils  and basophils indicate a myeloproliferative disease. This chemical property can reliably be applied to separate neoplastic from reactive forms of quantitative and qualitative leukocyte alterations. The developmental line of this specific myeloid cellular attribut has been presented to elucidate its diagnostic significance and its validity as proof for existence of a common promyelocyte from which neutrophils, monocytes, basophils and eosinophils originate.


Immunological follow-up of acute lymphoblastic leukaemia. In different treatment groups of children with acute lymphatic leukaemia and undifferentiated leukaemia, the lymphocyte count and a number of immunologic parameters were examined during the various stages of treatment. These parameters were related to the type of chemotherapy as well as the stages of treatment. This paper deals with the values of lymphocyte counts, of gamma globulin, IgG, IgM and IgA and the results of the DNCB skin tests, as a parameter for cellular immunity. IgG determined by acetate sheet electrophoresis showed no significnat change, while its significant reduction was shown during the periods of prophylactic reinduction with vincristine in the Pinkel VII scheme, The IgM level was significantly raised in the initial stage before treatment and in all periods of treatment both in the Pinkel VII group and in an earlier therapeutic group treated with methotrexate every two weeks and vincristine pulses every six weeks. IgA was raised in both groups before treatment but significantly reduced during the phases of maintenance and reinduction. About 50% of the P VII cases had negative DNCB skin tests during maintenance therapy, while all long-term survivors in the earlier methotrexate group had a positive skin test.


The effect of immunotherapy on survival of patients with acute myelogenous leukaemia after relapse. A randomized controlled clinical trial for the use of immunotherapy for maintaining patients with acute myelogenous leukaemia has been conducted involving 52 patients. All patients received short pulsed maintenance chemotherapy but 30 of the patients received additional immunotherapy consisting of BCG and irradiated allogeneic myeloblastic leukaemia cells. Of the 22 patients who received chemotherapy alone, 19 died with a medium survival of 39 weeks, whereas 20 of the 30 patients who received chemotherapy plus immunotherapy died with an estimated median survival of 74 weeks. The value for the significance of the difference in death rates of patients was less than .01. The main effect of this immunotherapy was, however, due to a prolongation of survival after the patients had relapsed; the median survival for the immunotherapy patients being 23 weeks compared with only 11 weeks for the chemotherapy alone patients (p less than .005). The overall results also show that there was a slight prolongation of first remission in patients who received immunotherapy with a median duration of 44 weeks compared with 27 weeks for patients who received only chemotherapy. The possible mechanisms of action of this form of immunotherapy are discussed.


Therapeutic results: report of the Hungarian children's leukaemia study group. In Hungary, the morbidity of leukaemia in children aged 0 to 15 years is 3.6/100,000. The rate of complete remission was 88.5% in ALL and 57.1% in AML. The most important factors limiting survival were infections acquired during induction therapy in 91.3% and during Co irradiation in 66.3% of the patients.


Treatment of acute lymphoblastic leukaemia. In acute lymphoblastic leukaemia the combination prednisone-vincristine induces more than 85% complete remissions. L-asparaginase which was used in complete remissions, seemed to increase their duration. Actually the best maintenance treatment consists in the combination of 6-mercaptopurine and methotrexate interrupted by reinductions. In other respects C.N.S. prophylaxis with intrathecal methotrexate and craniospinal irradiation is necessary. The well-known prognostic factors are: age, leucocytosis, tumoral syndrome, and cytological type: 216 cases of long remission have been observed. One group of these patients was treated by old methods: this represents 0.8 to 1% of the material, while 20% were treated by recent protocols with reinductions (20%).


Combination chemotherapy in adults with acute leukaemia. Ten patients with ALL and 35 with AML received combination chemotherapy at out Institute during the period 1972 - 1975. Patients with ALL were treated according to the L-2 protocol, those with AML according to the L-2, MRC 5/A, MRC 5/B and TRAP protocols. Nine of the 10 patients with ALL entered complete remission, and median survival time of these patients was 9.2 months. Four of the 35 patients with AML achieved complete, 13 partial remission. Median survival in this group was 4 months. Infection and bleeding represented the most frequent and severe forms of complication. Bleeding was well controlled by the administration of platelet concentrates, but infections were often lethal. The poor results were probably due to the high incidence of severe infections.


Comparative observations in the treatment of acute leukaemia. The results of treatment of 84 acute leukaemia patients during a 15-year period are reported. Sixty-three of the patients suffered from acute myeloid leukaemia, 14 had blastic crisis of chronic leukaemia and 7 had acute myelomonocytic leukaemia. Administration of prednisolone + purinethol, prednisolone + vincristine, and prednisolone + vincristine + purinethol combinations resulted in partial remission. The best results were achieved with the combination ARA-C + thioguanine + prednisolone, which produced complete remission in 2 out of 8 cases. One patient was refractory to this treatment.


Enzyme polymorphism in feral, outbred and inbred rats (Rattus norvegicus). Polymorphism at 25 loci coding for liver enzymes was studied in two feral, three outbred and three inbred rat strains by starch gel electrophoresis. No variation was found at 14 loci, and a low degree of polymorphism was detected at three. Eight loci were polymorphic in more than one population. The average degree of heterozygosity per locus per individual feral rat was 0-07. The degrees of heterozygosity observed in the outbred and inbred strains were lower, from 0-006 to 0-012. Contrary to expectation, the inbred strains were neither monomorphic nor appreciably less heterozygous than the outbred ones. The heterozygosity of the inbred strains was primarily due to two polymorphic loci, G-3-pdh and alpha-Gpdh. The reason for this polymorphism is probably the superior homeostasis of the heterozygotes.


Ribosomal DNA content and bobbed phenotype in Drosophila hydei. The number of ribosomal RNA genes in different Drosophila hydei stocks has been determined by filter saturation hybridisation experiments. It has been shown that there is no marked correlation between the average rRNA gene number per cell in the whole animal and the bobbed phenotype when Y chromosomal nucleolar organisers are present.


Variation in a natural population of Schizophyllum commune. Variation within the extreme isolates for growth rate. Two extreme dikaryotic idolates chosen from a large sample of a localised population of Schizophyllum commune exhibited a considerable amount of genetical variation for growth rate at the near ambient temperature of 20 degrees C and at the higher temperature of 30 degrees C. The potential variation within these extreme isolates were greater than the variation observed in the whole sample. Regression analysis of the variation in growth rate of the dikaryotic progeny of the extreme isolates on that of their component monokaryons showed that the nature of gene action was not the same in these two stages of the life cycle. The simple additive-dominance model of gene action was adequate to explain the variation in growth rate in both of the extreme isolates at both of the temperatures. The small deviations from this model could be accounted for by unequal gene frequencies due to small sample size although a low incidence of non-allelic interactions could not be rule out. Directional dominance for growth rate was detected in both isolates at the more normal temperature and it was opposing in direction in the two isolates. In the slow growing isolate the dominance was for faster growth and in the fast growing isolate it was for slower growth. This is expected for a character which displays overall ambi-directional dominance if isolates with more extreme growth rates than those recovered in the population sample are eliminated by stabilising selection. The dominance is temperature dependent being ambi-directional in both isolates at the higher temperature. Environmental heterogeneity, the buffering effects of directional dominance and genotype-environment interactions and opposing selective forces operating on the monokaryotic and dikaryotic stages of the life cycle are possible contributory factors to the considerable free and potential variability displayed in this small, localised population.


Unique multiple sex chromosomes of the tree mouse Vandeleuria o. oleracea: identification of X1 and X2. The tree mouse Vandeleuria o. oleracea has an odd diploid chromosome complement (2n = 29 female/male) accompanied by a unique multiple sex-chromosome mechanism (X1X2Ymale/X1X1X2female). In the present paper the sex chromosomes have been identified unequivocally with the help of G-banding and DNA replication patterns which confirm our earlier suggestion that the X1 is smaller in size than the simple mammalian X, and also that the combined sizes of the X1 and X2 (3-8 and 1-7 per cent respectively) approximate to the size of the conservative mammalian X (5 per cent). It is proposed that the mammalian X has attained a minimum functional size so that further reduction is not tolerated.


Affinity chromatographic purification of human lysozyme, with special reference to human leukemia lysozyme. Lysozyme [EC 3.2.1.17] was purified from human tears, serum, and urine of acute monocytic leukemia patients, renal disease patients, and residents in cadmium-polluted areas of Tsushima Island using an affinity adsorbent containing lysozyme-lysate of Micrococcus lysodeikticus cell walls as the ligand. By means of this procedure, leukemia lysozyme was purified 100- to 200-fold with an activity recovery of 80%. It was crystallized at pH 10. This purified preparation appeared homogeneous in disc electrophoresis and showed a specific activity 2.5-fold higher than that of crystalline lysozyme from hen egg-white. Tear lysozyme was also purified to a nearly homogeneous state while the enzymes from normal serum and urine of a nephrosis patient and of residents in cadmium-polluted area were still disc electrophoretically heterogeneous and showed low specific activity as compared with purified leukemia lysozyme.


The anatomy of the external palpebral ligament in man. The correct anatomy of the external palpebral ligament is demonstrated, based on microscopic studies. An analogy to the structures of the internal palpebral ligament is found.


Traumatology of the maxillo-facial region in childhood: (statistical evaluation of 210 cases in the last 13 years). A statistical study of fractures occurring in children with injuries of the head neck admitted to the clinic for Maxillo-Facial and Plastic Surgery of the Face, Düsseldorf, during the past 13 years is presented. The 210 cases were evaluated according to age, sex, frequency of occurrence, type, localisation and cause of injury, as well as therapy and average duration of treatment.


Transosseous wiring in the treatment of condylar fractures of the mandible. During 1973-1975, 27 patients with condylar fractures at the lower or middle level were operated on via the submandibular approach; 5 patients were under 14 years of age. The condyles were medially dislocated or severely displaced, leading to malocclusion. Various kinds of transosseous wirings were used and the mean time of intermaxillary fixation was 22.6 days. The follow-up study of the 27 patients was made on average 11.6 months after the operation. Postoperatively the mouth opening averaged 41.5 mm. There was a slight deviation of the chin (mean 2mm) to the operated side in half the cases. Lateral excursions were within normal limits. Slight motor weakness in the lower lip on the operated side was noted in 3 cases and mild pain in the operated joint in 8 cases. A radiograph revealed some shortening of the condyle in most cases, and some kind of angulation, mostly posterior, in half the cases. No tendency to ankylosis was found and totally normal and symmetric function of the joints was noted in 24 cases. In the light of the results of this follow-up study the method presented, which is not a very easy one, seems to be useful.


Multiple and total mandibular alveolar osteotomy. Surgical movement of teeth by alveolar osteotomy is described as a method of restoring occlusion. The use and advantages of metal "cap" splints is considered in the treatment of multiple and total segmental osteotomies of the mandibular alveolus.


A variation in the vertical osteotomy of the rami for correction of retrognathism: preliminary report. A new method for the surgical correction of mandibular retrognathism is proposed. With this method, the ascending ramus is osteotomized vertically from an extra-oral incision. The condylar segment is then inserted in a step, which has been cut in the mandibular segment, so that the mandible is fixed in its new advanced position. This step-like support of the segments obviates the tendency to relapse. This surgical procedure is a modification of the technique for vertical osteotomy of the ascending ramus described by Robinson (1957) for the correction of retrognathism.


The bucket-handle flap for closing fistulae around the premaxilla. A hithero unpublished vestibular flap for closure of oro-nasal fistulae in cleft patients is reported. 5 cases have been operated on with this technique so far. The surgical technique as well as possible complications and disadvantages are described.


Animation of facial palsy in Moebius syndrome by means of a circumoral sling: case report. The case of a 3-year-old female is reported whose condition was diagnosed as congenital, complete paralysis of the right facial nerve in 1962; and a short time later more specifically described as Moebius syndrome. In 1971, a circumoral fascial sling was inserted in preparation for a masseter muscle transfer. Voluntary movement on the right side of her mouth was noted following surgery and continued to improve, making facial actions more symmetrical. This function has remained stable during a five year follow-up. Although the mechanism of action is not fully understood, it is postulated that the presence of the sling may have presented the subclinically active muscles a force to work against or perhaps the surgery may have liberated those muscles from adjacent fibrous tissue.


Trismus resulting from central nervous system lesion. Three cases of unusual trismus are reported, occurring in patients with lesions of the central nervous system. On the basis of the clinical and electromyographical findings and observation of the course of the trismus this is interpreted as a symptom of a lesion of the brain stem, causing a dis-synergism of the masticatory muscles.


Clinical classification and staging in oral cancer. The literature regarding TNM-classification and staging as applied to oral cancer is reviewed and the shortcomings of the various systems are discussed. A new system for the classification and staging of carcinomata of the oral cavity is described. This system includes recording the site of the lesion (S) and the pathology (P) in addition to the conventional TNM criteria. The new system for staging involves the summation of arithmetic discriminants attached to each of the variables S, T, N, M and P. This system is more simple to use and is able to predict a more accurate prognosis for the patient.


TNM-classification of carcinomas of the oral cavity-efficacy of clinically available data (TN). Using adequate number of cases, the influence of the spread of primary tumour and the degree of regional metastasis on prognosis were investigated. Assuming a practicable classification as a prerequisite for clinico-therapeutic cancer research, experience has shown that the assessment of the spread of primary tumour alone does not suffice for the establishment of comparable homogenous data. The investigation on the importance of the degree of regional metastasis has shown, above all, that the percentage of N3-metastasis within the T-groups contributes essentially to the fact that these show a marked difference in their prognosis. It would therefore appear necessary also to examine the importance of other clinically accessible data in the assessment of prognosis. Only then could we be in a position to judge whether, and to what extent a clinically practicable classification and integration into special groups is possible on the basis of clinically available data. The inclusion of more clinics in the joint investigation is encouraged.


Desmoplastic fibroma of the mandible: case report. This report describes the case of a 2-year-old girl with desmoplastic fibroma of the mandible, with swelling in the region of the mandibular angle which had been wrongly diagnosed several times. A biopsy was interpreted as showing a low-grade fibrosarcoma. The patient then received treatment with cytotoxic drugs, and later a mandibular hemi-resection was performed. The postoperative diagnosis was Jaffé's desmoplastic fibroma (non-osteogenic). The age of the patient, the rapid development of the tumour and the accompanying pain suggested a sarcoma, and the first pathological examination seemed to provide confirmation. The post-operative course was very favorable, and the patient is considered to clinically cured, after one year.


Angiolipoma of the hard palate: a case report and review of the literature. A case of a large angiolipoma of the hard palate is presented. This constitutes a new site for this type of tumour.


Bilateral aplasia of the nose: a case report. After presenting a case of bilateral agenesis of the nose, and description of normal morphogenesis of the face, an explanation for the malformation is sought. The comparison of non-existent, rudimentarily preformed and existing elements with normal facial morphogenesis leads to the assumption of an incomplete formation of the frontal process, which has led to a hypoplasia of the secondary processes (nasal processes). The reason is advanced for abandoning the construction of a functioning nose and the reconstruction of the external nose is described.


Thromboelastographic changes in carcinoma: an animal model. The dynamics of blood clotting using a thrombelastogram (TEG) are depicted after the injection of V2 carcinoma cells or control heterologous peritoneal exudates in New Zealand hares. Changes in the TEG configurations of native blood samples vs. celite activated samples run simultaneously provide a qualitative assessment of the presence of carcinoma.


Adenosine aminohydrolase from human spleen: partial purification and some kinetic properties. Adenosine aminohydrolase from human spleen was purified 120 fold. In pH 7.3 phosphate buffer at 37 degrees, this enzyme preparation deaminated adenosine and arabinosyladenine (ara-A) with apparent values for the Michaelis constant of 40 muM and 90 muM respectively. The products of both deamination reactions, i.e., inosine and arabinosylhypoxanthine, were competitive inhibitors with Ki equal to 710 muM and 60 muM, respectively. N6-benzyladenosine and 2'-deoxy-N6-benzyladenosine were competitive inhibitors. The former was better able to inhibit ara-A than adenosine deamination, while the latter was equivalent in inhibiting deamination of these two substrates. Evidence for a naturally occurring adenosine aminohydrolase inhibitor in spleen was presented. It is suggested that benzyladenosine and deoxybenzyladenosine might potentiate ara-A chemotherapy of neoplasms and metastates in the spleen and other hemic cells.


Protective effect of allopurinol on bronchiolar constriction induced by histamine. In order to examine the protective effect of allopurinol on experimental asthma produced by histamine aerosol in guinea pigs, allopurinol was administered intraperitoneally resulting in a significant prolongation of survival times. Significant elevation of blood ATP levels was shown in guinea pigs pretreated with allopurinol compared to the control guinea pigs. It is thought that this beneficial effect prevents the loss of functional purine base.


Thymidine and uridine degradation by nucleosidases of cultured human lymphoblastoid cells. Cultured human lymphoblastoid cells of different lines elaborate rapidly pyrimidine-specific nucleosides when incubated as a dense population in a serum-containing milieu. No appreciable changes in viability or morphology were detected in the time required for maximal enzyme production. These nucleosidases degraded thymidine, uridine and cytidine; adenosine and guanosine were not catabolized. Cell viability and proliferation were not affected by these heat-labile and ultraviolet-sensitive enzymes. Products arising from nucleosidase degradation of radiolabeled pyrimidines, which were separated and identified by paper chromatography, were not incorporated by DNA- and RNA-synthesizing lymphoid or nonlymphoid cells.


Bioenergetics in clinical medicine. XI. Studies on coenzyme Q and diabetes mellitus. The activity of the succinate dehydrogenase-coenzyme Q10 reductase from 120 diabetic patients was significantly lower (P less than 0.001) and the per cent deficiency was significantly higher (P less than 0.001) than that of the controls. The diabetes of 37 patients was controlled by diet; the enzyme activity was lower (P less than 0.001) and the deficiency was higher (P less than 0.02) than for controls. In decreasing effectiveness, Dymelor, Glyburide, Phenformin and Tolazamide inhibited the COQ10-enzyme, NADH-oxidase. Tolbutamide, Glypizide, and Chlorpropamide were noninhibitory to succinoxidase and NADH-oxidase. Patients receiving Tolazamide and Phenformin showed a higher incidence (P less than 0.001 to P less than 0.05) of COQ10-deficiency than patients controlled by diet or normal controls. Certain diabetic patients controlled by diet may have a deficiency of COQ10 which may be enhanced by the inhibition by certain commonly used antidiabetic drugs of COQ10-enzymes. A deficiency of COQ10 in the pancreas could impair bioenergetics, the generation of ATP, and the biosynthesis of insulin.


Diuretics in malignant effusions and edemas of generalized cancer. Forty patients with generalized cancer complicated by water and electrolyte retention were treated with "medium" and "large" doses of furosemide and bumetanide with 35% and 40% objective positive response, respectively. A smaller percentage of patients benefited from these diuretics, mainly in the quality of their lives. Peaks" of diuresis lasting a few days were observed in positive diuretic response. It is therefore concluded that diuretics may be more effective in malignant conditions if administered in a "high-dose pulse" therapeutic schedule.


The effects of single administration of an antitumor platinum compound on ornithine decarboxylase activity in certain tissues of mice bearing L1210 leukemia. A single dose of cis-dichloro(dipyridine)platinum(II) (cis-PPC), when given to BDF1 mice bearing 1-day-old L1210 leukemia, suppressed the increase of spleen and liver ornithine decarboxylase (ODC) activity which occurs concomitantly with development of the leukemia. The inhibition of ODC, the rate-limiting enzyme in polyamine synthesis, appeared to correlate with the prolonged chemotherapeutic efficacy of a single dose of the platinum complex. These observations suggest an additional mechanism by which platinum complexes express their antitumor actions and, in addition, support the view that polyamine synthesis and excretion patterns can be used as predictors of chemotherapeutic response.


Regulation of resistance to various toxicants by PCN (pregnenolone-16alpha-carbonitrile) and thyroxine. In rats, PCN (the most potent catatoxic steroid known to date) at the usual dose level powerfully inhibited the toxicity of antazoline, carbamazepine, cocaine, guanethidine, ibuprofen, ketamine, LSD, nembutal and reserpine, whereas (except in the case of nembutal) thyroxine sensitized the animals to intoxication with these same compounds. Even much lower doses of PCN or thyroxine exerted similar but weaker effects. PCN-induced resistance to the various substrates was generally not altered by concurrent administration of thyroxine but in a few cases its protective action was partially or totally inhibited, depending upon the respective dose levels of both compounds.


Three hour hemodialysis with double coil dialyzer. Blood urea nitrogen and weight reduction can be accomplished in renal failure by doubling the surface area of the standard dialysis coils. This results in a reduction of time on the machine, drugs and personnel utilization.


Anatomical aspects of implantation.

Anatomical aspects of implantation. Although there is a fascinating variety of morphological relationships at different stages of implantation in various species, some common patterns can be discerned. The position within the uterus where blastocysts are found after transport is the end result of the activity of the uterine musculature, the endometrical conformation, and the size and shape of the blastocyst. Blastocysts of some species are situated in the approximate position where they will implant for an appreciable period of time. Apposition, brought about by blastocyst swelling or uterine lumincal closure, is the necessary prerequisite for the initiation of adhesion. Adhesion per se is progressive and involves the surface coats of the trophoblast and uterine luminal epithelial cells. It maybe thought to include such events as the development of adhesive factor(s) on the trophoblast and the local deletion of some of the uterine coat constituents. When adhesion is followed by invasion of the uterine mucosa, the trophoblast adheres closely to the uterine epithelial cells, sharing junctional complexes with healthy cells, and engulfing displaced or surrounded cells.


[Restrictions on opening of the mouth caused by extra-articular inflammation]. Recent views concerning the physiopathological aspects of restrictions on opening of the mouth attributable to extra-articular inflammation are examined. Stress is laid on the importance of psychological factors related to joint function and various organs and apparatuses that interferere with such function by reflex action via the brain. Instances of extra-articular inflammation limiting opening of the mouth are listed, with particular reference to primary and secondary myositis and myositis ossificans. Inflammation may also supervene in osteodysplasia, granuloxanthomatous hyperdysplasia of the maxillary bones, while opening of the mouth may be restricted by fibrosis of the muscles used in mastication due to protracted immobilisation, as in ankylosis of the T.M.A. Lastly, the way in which inflammation accompanying diseases of the salivary glands, dysembryoplasia, and jaw and mouth cavity neoplasia may prevent proper opening of the mouth is explained.


[Variability and correlations of missing and decayed teeth in Sicillian adolescent grouped by age and sex]. Overall and individual tooth morbidity were assessed in relation to mouth section, age and sex in 1,761 poor Sicilian adolescents aged 14 to 20 yr with decayed teeth or teeth extracted for decay. Statistical assessment of the findings in the upper and lower arch was undertaken in a search for related differences (increases or decreases) in the number of decayed or extracted teeth in each arch. The dependence on differences between one area and another on the variables considered was also examined in terms of their statistical significance. No sex-based difference emerged. The frequency of decay or extraction was usually a function of position. Both the upper and lower right or left 6th teeth (i.e. those in the middle position) were most commonly affected in males and females. Use was thus made of Vianelli's index in determination of the statistical asymmetry of teeth decayed or extracted on either side of the 6th.


[Applications of the ETCH technic and orthodontic brackets in some clinical cases]. The Authors shawed how the sealants having a resin base that can establish with tooth surfaces treated with acid, a sound connection among these and orthodontic brackets, originally used in orthodontic treatment, can also be used for fixation of fractures. The case described concern seven patients with a fracture of maxillaries. It was demonstrated that such a procedure was easy to execute for the operator and did not give any trouble to the patient. The results obtained were satisfactory.


[Histogenesis of adamantinomas].

[Histogenesis of adamantinomas]. Following some general remarks on the histogenesis of adamantinomas, the results of histological research on the periodontal tissues, the walls of dental cysts and 21 cases of adamantinomas are reported. Results back up the hypothesis that adamantinoma-like tumours may derive from epithelial residue in the periodontal tissue in the wall of dental cysts and from cystic epithelium itself. It is also shown that the basal stratum of the oral epithelium may give rise to adamantionoma-like tumours which could be regarded as adamantine baseliomas rather than as odontogenous adamantinomas proper.


[Percutaneous cervical chordotomy].

[Percutaneous cervical chordotomy]. On the base of 52 percutaneous and 25 open cervical cordotomies, the technique, results and complications of the former are described in detail. The comparaisons of the results and complications shows that both methods are equals. 92,5% of excellent and good early results by percutaneous and 96% by open cordotomy were obtained. The longterm results of about 60% of good results for both methods are concordant to the litterature. Percutaneous cordotomy seems to give more stable analgesic levels. The complications and their mechanisms are discussed in detail and the dangers of high cervical cordotomies, even unilaterals, are outlined. The special risks of bilateral operations in which mortality is twice as high are shown. It is concluded that percutaneous cordotomy is as effective and secure as the open procedures but less aggressive. By this method even poor-risk patients can be treated. The fact that one is limited to a high cervical level represents a real disadvantage, so that classic techniques still have their indications.


Sensitivity of 941 beta haemolytic streptococci to antibacterial drugs. Nine hundred and forty-one strains of beta haemolytic streptococci were Lancefield grouped and their antibiotic sensitivities tested by the agar plate diluting technique to penicillin, erythromycin, lincomycin, tetracycline and sulphafurazole. All the strains tested were sensitive to two units per ml or less of penicillin. This MIC is higher than that reported in other surveys and indicates increasing resistance of these organisms to penicillin. All the strains tested were sensitive to two mug/ml or less of erythromycin. Fifty percent of all strains were resistant to tetracycline and sulphafurazole.


Rheumatic fever in New Zealand: the Waiora College survey design and response rate. The outline organisation of a health survey of a secondary school is presented. The aims of the survey were primarilary to provide population data on rheumatic fever in a high incidence area, and to further knowledge of the distribution of risk factors for coronary heart disease in New Zealand adolescents. Ninety-six and a half percent coverage of the target group was achieved; non-responders were characterised from hospital and school records as being predominantly rural with greater early childhood hospital experience than respondents. The sample was considered to be representative of the adolescent population of the area.


One year's rheumatic fever from one general practice in Wairoa, Hawke's Bay. Sixteen cases of rheumatic fever from one general practice are described and the indication for prophylactic penicillin is discussed.


Successful bismuth (De-Nol) therapy for gastric ulcer. Fourteen patients with chronic gastric ulcer were treated with a bismuth preparation (De-Nol) on an outpatient basis. The healing rates were good as with hospital admission and better than a control group of outpatients.


Survey of ophthalmic surgery in North Canterbury and Westland (1970-1975). The major ophthalmic operations performed in the Christchurch hospitals over five years are listed. This gives the incidence of ophthalmic conditions requiring surgery in a mainly European Community. The results should be useful for planners and epidemiologists in this and others countries.


Report on five and a half years of the Cancer Detection Centre, Aukland Division, Cancer Society of New Zealand. An account is given of the setting up of a cancer detection centre at Auckland. In the first five-and-a-half years 3001 patients were examined. Forty-two cancers were detected and 1056 patients had non-malignant medical diseases.


The effect of an occlusal interference on the masticatory system. An experimental investigation. An experimental short term study on the effect of an occlusal interference on the path of closure of the mandible was carried out on 8 persons. The interference consisted of a gold inlay placed unilaterally in one of the mandibular first molars. Clinical and electromyographic studies revealed functional disturbances or pain in all subjects. The masticatory musculature was tender to palpation and showed coordinational disturbances; the TMJ showed tenderness to palpation, clicking and irregular movements and the interfering teeth periodontal tenderness.


Motor pause frequency in the masseter muscle in relation to food texture. EMG activity was recorded from the masseter muscles of 10 naturally dentate subjects during the chewing of hazelnuts, peanuts, Optosil and chewing gum. The frequency of motor pauses (10-50 ms long) in the EMG patterns was found to be related to the textural properties of the test food. It was also found that the frequency varied for different parts of the chewing sequence, being significantly higher initially than in the last part of the chewing sequence. Motor pauses of this length, however, were absent from many of the EMG patterns. It is concluded that these motor pauses are signs of certain events during chewing but are probably not part of any basic reflex necessary for the neurophysiological regulation of chewing.


The influence of carbon content on the mechanical properties in a cast dental Co-Cr alloy. By varying the amount of acetylen in acetylene-oxygen flames Co-Cr test pieces with a varying carbon content were produced. The hardness, yield point for 0.05 per cent, 0.1 per cent and 0.2 per cent tensile strength and elongation were determined for these test-pieces. The results showed that hardness, yield points and tensile strength increased with increased carbon content, whereas the elongation lessened. The clinical importance of the altered mechanical properties due to increased carbon content in the Co-Cr alloy under study was discussed.


The influence of different heat treatments on a dental Co-Cr alloy. The change in microstructure and hardness in a cast Co-Cr alloy (type A) with a carbon content of 0.45% was studied both when the alloy was aged at temperatures between 600 degree C and 1200 degrees C and when it was isothermically heat-treated at temperatures between 800 degrees C and 1000 degrees C after solubility treatment at 1200 degrees C. Furthermore, studies were undertaken on how aging at 800 degrees C, solubility treatment at 1200 degrees C and isothermal heat treatment at 800 degrees C after solubility treatment at 1200 degrees C affected the mechanical properties. The results showed that both aging and isothermal heat treatment could change both microstructure and hardness. The changes in the mechanical properties by heat-treatment, however, did not improve the usefulness of the alloy in dentistry, principally because the elongation was reduced. The change in microstructure explained the change in hardness and in mechanical properties. It was interesting to note that the properties of a Co-Cr alloy were not affected by heat-treatment at temperatures below 600 degrees C. This means that addition of gold alloys, which are soldered to a base of Co-Cr, can be both homogenised and/or hardened without affecting the properties of the Co-Cr alloy.


Studies on short-term application of drugs to Eimeria tenella in tissue culture. The anticoccidial action of 6 drugs was studied by treating cell cultures with drug for 24 h after inoculation of the cultures with sporozoites of Eimeria tenella. A monitoring technique was used to confirm that the drug was being removed. Only monensin was shown to be coccidiocidal. Amprolium, lasalocid, methyl benzoquate, nicarbazin and robenidine were coccidiostatic at their minimum effective doses. Misleading coccidiocidal effects were observed when higher concentrations of methyl benzoquate, nicarbazin or robenidene were used.


[New chromosome abnormality in chronic myeloid leukemia]. A case of chronic myelogenous leukemia with myelofibrosis and failure to respond to busulfan therapy has been reported. An abnormal clone with a rearrangement of four chromosomes, 46, XX, t(1;9) (q21; q24), t(6;22) (q26;q11) was observed. The possible significance of these chromosome abnormalities which are different from the t(9;22) translocation in C.M.L. is discussed.


[Membrane glycoproteins and platelet protein glycosylation in chronic myeloid leukemia]. SDS-polyacrylamide gel electrophoresis of solubilized whole platelets and isolated platelet membranes from patients with chronic myeloid leukemia (CML) as compared to the normal platelet-Schiff-stained glycoproteins (GP) (noted GP I, II, III of app. MW 155, 130 and 100.10(3) daltons, respectively), showed the following modifications: the decrease of GP I; the presence of the GP II and GP IIx doublet; the moderate and variable decrease of the GP III; the increase of the platelet glycolipid. No significant differences were detectable on the polypeptide patterns from CML platelets in respect to the normal 20-25 protein constituents. Using a radio-isotopic method it has been measured as an elevated catalytic transfer of the galactosyl and N-acetylgalactosaminyl residues from nucléotide 14C sugar derivatives onto the endogenous acceptors of platelets from CML. The results obtained suggested that CML platelets with recognized abnormal functions, have modifications at the level of the macromolecular surface glycoprotein constituents and/or changes of the glycoconjugates reactive structures involved in the devopment of the periodic acid-Schiff reaction as also in the transfer reaction of the sugar residues.


The WHO classification of bone tumors.

The WHO classification of bone tumors. The WHO scheme of classification of bone tumors is based on histologic criteria. It simply lists the main types of primary bone tumors; knowledge of histogenesis or of tumor origin is implied only for certain groups of lesions. This international agreement on nomenclature and classification of bone tumors would greatly aid comparative population studies on bone tumors in different parts of the world.


Primary malignancy, secondary malignancy and semimalignancy of bone tumors. 1. Bone tumors in contrast to tumors in soft tissue, show a wide variety of clinical behavior qualified by the expressions semimalignancy, low grade of malignancy, sarcomatous degeneration and primarily benign bone tumors and bone lesions. 2. The term semimalignancy is characterized by local invasive and destructive tumor growth with a tendency to recur locally but no hematogeneous spreading. Semimalignancy requires wide en-bloc resection of amputation. 3. The term low grade malignancy is used to describe a tumor of very slow growth and with very late metastasis. Low-grade malignancy requires resection with careful preservation of functional structures. 4. The term secondary malignancy means the sarcomatous degeneration of a primarily benign lesion or bone tumor. This transformation is enhanced by irradiation and probably by acceleration of the normal turnover of bone tissue. In Paget's disease sarcomatous degeneration is to be expected in 2 percent of cases and in fibrous dysplasia in 0.5 percent of cases. 5. Sarcomatous degeneration of bone infarcts is rare, but an increase is to be expected due to an increased frequency of bone infarcts caused by long-term treatment with cortisone. 6. Primary bone tumors and recurrences show the same structure and cytology. In a minority of cases the recurrences are less differentiated; in a very few cases the recurrences are more highly differentiated and have a better prognosis than the initial lesion.


Common errors made by pathologists in the diagnosis of bone tumors. The pathologist must obtain X-rays before attempting to make a diagnosis in a bone tumor. Errors are made with both benign and malignant lesions associated with calluses. Infection may stimulate a malignant bone tumor radiographically and pathologically. Secondary aneurysmal bone cyst may dominate the radiographic and pathologic findings and obscure the primary diagnosis. Osteoblastomas are becoming increasingly difficult to diagnose. The question of whether such an entity can become malignant has not been resolved. Cartilagenous tumors are often difficult to diagnose and the pathologist must not only rely on histologic findings, but in particular pay attention to the radiographic pattern which is often diagnostic. Accuracy of diagnosis in Ewing's sarcoma is essential because the treatment now can result in a cure rate of almost 40%. Certain lesions such as lymphoma or osteosarcoma can mimic this tumor. To re-emphasize the problem, the pathologist must have all the clinical information before attempting a diagnosis of a bone tumor and without the pertinent X-ray, errors are almost inevitable.


Aspiration (puncture of needle) biopsy in bone lesions. In certain bone tumor cases bone puncture is more profitable than sample excision. Whenever necessary we are using both methods in our practice. The results of 7165 puncutre biopsies are presented. A definite diagnosis by needle biopsy could be established in 771 tumors, including 254 myelomas and 174 osteogenic sarcomas. The aspiration or needle biopsy will require some experience not only on the part of the pathologist, but also of the surgeon. The pathologist must be sufficiently familiar with the clinical and radiographic evidence before interpreting the cytologic or the histopathologic specimen.


Histochemical and electron-microscopic aspects of bone tumor diagnosis. In recent years, histochemistry and electron microscopy have been applied more and more to the investigation of bone tumors. The contributions and limitations of these methods in differential diagnosis are discussed. The levels of glycosaminoglycans in cartilaginous tumors display distinct differences between slow- and fast-growing types. All cartilaginous tumors are poor in phosphatase activity. Demonstration of these enzymes at acid and alkaline pH in bone-forming conditions reveals differences between benign and malignant tumors. Osteosarcomas display a rich activity of both phosphatases in bone-forming and in bone-free regions. Acid phosphatase may play a rôle in the breakdown of the host tissue infiltrated by the tumor. Electron microscopy of bone tumors has brought out some interesting findings. In fibrous dysplasia a particular kind of very fine fibrillar structures was observed besides the regular collagen fibrils. This may indicate retardation of collagen maturation. Cell organelles in benign and malignant bone tumors usually differ quantitatively. They resemble active fibroblasts. In bone- and in cartilage-forming tumors we observed large quantities of microfilaments in the cytoplasm. Nuclear indentations and invaginations probably indicate increased nuclear activity. The intense acid phosphatase activity demonstrated histochemically seems inconsistent with the low number of lysosomes in the cytoplasm of osteosarcoma cells, but other organelles (Golgi apparatus and vesicles) may also contain the enzyme. Virus-like particles have not been observed in human osteosarcomas up to now. Other authors have observed a correlation between the number of cell organelles and the grade of differentiation, but this was not detected in our sample of benign and malignant cartilaginous tumors. Histochemistry and electron microscopy of bone tumors are still in the early stage of material gathering. Some histochemical findings, however, can already be used as diagnostic tools.


Bone tumors induced by inhalation of 238PuO2 in dogs. Plutonium-238, an alpha-emitting radionuclide, is used as a heat source in thermoeleltric power generators such as have been employed on lunar expeditions of communications satellites and in cardiac pacemakers. It has an 86.4 year half-life and emits 5.5 MeV alpha particles. Beagle dogs were given single 10-30 minute exposures to 238PuO2 aerosols to study the long-term translocation of plutonium and biological effects. Dogs with a terminal body burden ranging from 7-260 muCi were euthanized due to respiratory insufficiency related to plutonium-induced pneumonitis during the first 3 years after exposure. Nine of the 11 dogs euthanized during the 4-6 year postexposure period had osteosarcomas. The terminal plutonium body burden in the tumor-bearing dogs ranged from 0.5-2.6 muCi with 30-55% of the plutonium in the skeleton. Experiments are in progress to further define the dose-effect relationship of inhaled 238PuO2 and investigate the mechanisms of plutonium-induced neoplasia.


The immune-status in patients with bone and soft-tissue sarcomas. The immunologic status of 50 sarcoma patients was established. It was possible to apply the DNCB test and the recall antigen test in most cases during the course of the illness. The PHA stimulation of the lymphocytes and their cytotoxicity on homologous sarcoma cell lines were also correlated with the course of the illness. Nonspecific tests related neither to each other nor to the development of the illness while the tumor-specific cytotoxicity test correlated closely with the course of the disease.


The treatment of malignant bone tumors by conservative surgery. The indications for local radical en-bloc resection are discussed. The preoperative work-up and the aspects to be considered before surgery are detailed, and specific diseases, operations, and experences are illustrated.


Experimental induction of bone tumors by short-lived bone-seeking radionuclides. Single and repeated applications of 224Ra and single applications of 227Th to more than 600 female NMRI mice 3 - 4 weeks old, and to male NMRI mice have led to a high rate of osteosarcomas. Tumor incidence is dose-related. 227Th is more carcinogenic than 224Ra which induced the highest tumor incidence of 60% after a single injection of 5 muCi per Kg body weight or more. Repeated injections of 224Ra to female mice yielded a tumor incidence of up to 92%. Most of these osteosarcomas consist of well-differentiated bone-forming osteoplastic tissue. Half of the tumors occurred in the spine, particularly in the lumbar region. In protraction experiments, multifocal osteosarcomas have been observed. Less than 10% of the mice with osteosarcoma had developed metastases in lung, spleen, liver, and kidney. The possible mechanisms of the protraction effect are discussed.


Etiology of childhood bone cancer: epidemiologic observations. In dogs, osteosarcoma is markedly more frequent in giant breeds than in small ones. Ewing's tumor rarely occurs in species other than man. In children, both osteosarcoma dne Ewing's tumor appear to be related to the rate of bone growth. Nonradiogenic osteosarcoma occurs excessively in persons with the heritable form of retinoblastoma, and in certain malformation syndromes, some of which are known to be genetically induced. Osteosarcoma may also be of the heritable type when it is multicentric or aggregates in families. The neoplasm may occur excessively in certain families with specific cancers not involving bone. By contrast, the only evidence of a genetic influence on Ewing's tumor is its near-absence among blacks in the United States and in Africa. The only exogenous agent known to induce osteosarcoma (but not Ewing's tumor) in man is ionizing radiation in substantial doses. There is no epidemiologic evidence for the virus etiology of bone cancer in man. Despite the epidemiologic differences between osteosarcoma and Ewing's tumor, both histologic types occasionally occur in different portions of the same neoplasm.


Effect of rib cage or abdomen compression at iso-lung volume on breathing pattern. In anesthetized rabbits a small compression of the rib cage (RC) caused a marked increase of breathing frequency (f), a marked reduction of expiratory duration (Te), a reduction of inspiratory duration (Ti) and tidal volume (VT), while an equal decrease of lung volume produced by abdominal compression(AC) caused a smaller increase of f and no change of Ti, and a slight increase of VT. Similar results occurred when normal end-expiratory volume was maintained during compression. The phenomena disappeared after bilateral vagotomy, whereas persisted after cordotomy in T1. Similar results occurred in dogs (with the exception that VT decreased during AC), whereas in cats only RC increased f by shortening Te. RC caused a marked increase of discharge in 11 out of 19 irritant receptor fibers, whereas AC caused an increase only in 2. In most of the pulmonary stretch receptor fibers the change of activity produced by compression paralleled the lung volume change. The effects of vagal cooling on Ti, Te and the VT-Ti relationship with and without compression suggest irritant receptors as responsible for the different ventilatory pattern during RC and AC.


Effect of vagotomy on the response of gastric myoelectrical activity to glucagon and food. The myoelectrical activity of the gastric antrum was measured in 13 patients using intraluminal suction electrodes. In 3 patients with intact vagi, intravenous injection of glucagon 5 mug/kg and 10 mug/kg resulted in periods of increased frequency of gastric slow waves and also periods of inhibition. These findings persisted after highly selective vagotomy (7 patients) and were abolished by truncal vagotomy (3 patients). In each of 4 dogs, six silver/silver chloride electrodes implanted under the serosa were used to record the myoelectrical activity of the stomach and duodenum and its response to a meal of 450 gm of meat. Coordination of bursts of spike activity superimposed on the slow waves was significantly diminished after truncal vagotomy but not after highly selective vagotomy. These results confirm that changes in myoelectrical activity after vagotomy are related to the extent of vagal denervation.


[The development of the perfectly adapted MOD composite filling material with tight marginal fitting in vitro findings]. Class II Adhesive Restorations have been realized with composites under laboratory conditions. They show a perfect marginal adaptation and no microleakage at the tooth/restoration interface. These properties were obtained a) with a new cavity preparation, b) by application of a low viscosity sealant prior to the placement of the bulk of the composite material. The Adhesive Restoration compared favorably with conventionally prepared restorations. Nevertheless, enamel conditioning with acid and the use of a low viscosity sealant in conventionally prepared class II cavities resulted also in some improvement of marginal adaptation.


[Cracks in the dental enamel caused by sensitivity testing with CO2 snow and dichloro-difluoromethane--a comparative in vivo study]. With the aid of permeating dye and standardized fluorescence UV-photography, the reaction of subjects and enamel to the application of two pulp vitality testing methods (frozen carbon dioxide and Frigen -pellets) was examined. The enamel lamella system, the diffusion of temperature changes through the tooth crown and the thermodynamic pattern of enamel and dentine are described in detail. Structural changes of enamel as well as the subject's reaction times to a cold stimulus during the vitality tests are documented and the data are compared. Frigen caused less enamel changes than did frozen carbon dioxide. The subject's reaction times were similar for both methods. There were no differences between the methods with regard to the number of reopened, extended and newly created enamel fissures. However, the length, width and depth of these fissures proved to be less pronounced for Frigen than for carbon dioxide. Clinical implications of the results are discussed.


[Dental hygiene indices for dental practice (methods and experiences)]. An oral hygiene recording sheet for clinical practices with a dental hygienist is described. The recording sheets allow an easy and clear survey of the present oral hygiene status as well as progress or negligence in the performance of oral hygiene procedures. Several oral hygiene indices are described, three of which are recommended for routine examinations: The plaque index of Silness/Löe, the sulcus bleeding index of Mühlemann/Son and the calculus surface index of Ennever et al. The experience of a 3-year use of the oral hygiene recording sheets is described.


[Peridontal conditions in a group of Tibetans]. The possible role of race in periodontal disease has not been thoroughly investigated. As a basis for further discussion regarding this problem, the periodontal status of a group of Tibetans consisting of 38 children and 88 adults was investigated. The parameters evaluated were as follows: in the children the Sulcus Bleeding Index (SBI) and in the adults the modified Periodontal Disease Index (PDI). The results of this study showed that 13 children were free of gingivitis. The PDI was between 3,77 and 4,00 for the 18--19-years old and between 4,72 and 4,90 for the ones over 19 years. Since the PDI values were relative high and the gingival crevice depths were relatively low one can conclude that gingival recession accounts for the major portion of the PDI score.


[Intraligamentary anesthesia with the "Peripress" syringe]. The authors have been using for some time the intraligamentary anaesthesia with the Peripress syringe in their own practices. They consider this syringe as an instrument for efficient and rational working and as an improvement of the local anaesthesia techniques. After specifying the instruments they describe in all detail the injection technique which allows all current work on teeth like extractions, cavity preparation and stumps for crowns, endodontic treatments requiring anaesthesia, all this without loss of waiting time. The intraligamentary anaesthesia does not cause any secondary troubles if carefully applied. It causes very little pain if at all. It allows to start dental work immediately after infiltration and avoids block anaesthesia for current dental work. Patients are favourable to the method. They prefer this type of anaesthesia.


[A new local anesthetic for dentistry. Current research following a literature review]. A new local anaesthetic from the Thiophen series is described from literature and from clinical experience. It has several advantages over the currently used anaesthetics.


[The masticatory muscle synchronizer. Guided functional therapy of myoarthropathies of the tempors-mandibular joint]. In the myoarthropathies of the masticatory organ, psychic factors, often coupled with occlusal disturbances, have a trigger function. If the psychic factors prevail, the disturbances of the occlusion as etiologic factors diminish or are totally absent. In such patients, we often find fronto-lateral bruxism without any premature contacts in evidence. A guided functional therapy is introduced. With the so-called synchronator for masticatory muscles, a backfeed programming of the dysfunctional mandibular motion pattern is provoked into the normal neuromuscular harmony. This is done by obtaining centric relation and by blocking the fronto-lateral parafunctional pattern by rebuilding measures.