Adenine phosphoribosyltransferase deficiency: its inheritance and occurrence in a female with gout and renal disease. A deficiency of adenine phosphoribosyltransferase (APRT) enzyme activity to approximately 40% of normal has been found in erythrocytes from a young woman aged 24 years, who had suffered from recurrent gouty arthritis since 11 years of age. She also demonstrated considerable, although asymptomatic, renal impairment with a creatinine clearance of one-third normal. Her father had suffered from gouty arthritis but had a normal APRT activity; he was obese, had a high purine intake and was a regular beer drinker. The patient's mother was asymptomatic with a normal serum urate concentration, but demonstrated a similar reduction in APRT activity to that of her daughter. Eleven other asymptomatic members of the family also demonstrated a similar reduction in APRT activity in erythrocyte lysates. The pattern of inheritance was consistent with autosomal transmission. Concentrations of phosphoribosylpyrophospate (PRPP) in erythrocytes were within normal limits both in the subjects with deficient, and in those with normal, APRT activity. Partial purification of APRT enzyme from erythrocytes of the index case did not reveal any difference from the normal enzyme as far as Michaelis constants, heat stability, or mobility in polyacrylamide gel was concerned. No primary abnormality of lipoprotein metabolism was demonstrated either in the propositus or in other members of her family. Study of urate metabolism in the propositus indicated that, although urate production was within the normal range in absolute terms, there was increased incorporation of glycine into produced urate, usually taken as one index of de novo urate production. Impaired renal excretion of urate was also shown. Although detailed study of urate metabolism has not been undertaken in other family members with APRT deficiency, no conclusive relationship has yet been demonstrated between APRT deficiency and disordered urate metabolism.


Pyelo-ureteritis cystica associated with a urinary tract infection due to a coagulase-negative staphylococcus. A young female presenting with a history suggestive of renal colic was found by intravenous pyelography to have Pyeloureteritis Cystica. In association with this condition she had a urinary tract infection due to a coagulase-negative staphylococcus. Following a two week course of appropriate antibiotic therapy, her urine became sterile and repeat pyelography revealed no abnormality.


Epidemic polyarthritis: a cytological, virological and immunochemical study. A patient with epidemic polyarthritis was studied within 48 hours of onset when specific serum antibodies were still low. The synovial fluid showed a fall in hyaluronic acid level and rise in protein levels though the immune globulins, and especially IgM, rose to a lesser degree and remained well below the levels in the serum. Attempts to grow virus from synovial fluid or blood lymphocytes failed despite the use of several new techniques. The complement components C'3 and C'4 were not depleted in serum or synovial fluid. The synovial fluid was devoid of neutrophil leucocytes, and contained predominantly monocytes and macrophages which were remarkable for mitotic and for enhanced and indiscriminate phagocytic activity. From this and other evidence, an explanation is proposed for the cytological response and difficulties in recovering infective virions in virus-induced arthritis. No virus antigen was detected in the supernatant synovial fluid and electron microscopy showed virus-like particles only in cytolysosomes.


Rational therapy for thyroid storm.

Rational therapy for thyroid storm. An approach to the management of patients with thyroid storm is described. The treatment regimen, which is directed against the abnormalities as they are presently understood, incorporates: (a) Propranolol to inhibit the catecholamine-mediated peripheral effects of the circulating thyronines; (b) Propylthiouracil to inhibit thyroid hormone synthesis and to inhibit peripheral conversion of thyroxine to triiodothyronine (T3), the predominant source of T3 production; (c) Iodine to block the glandular release of thyroid hormones; (d) Dexamethasone along with general supportive therapy. The regimen has been used for a 13 year old schoolgirl with thyroid storm, and the induced rapid fall in serum T3 levels is illustrated. It has also been used in patients with florid thyrotoxicosis undergoing emergency surgery and has resulted in marked clinical improvement associated with rapid decreases in serum T3 levels. It is a simple and efficient regimen, rendering cumbersome forms of therapy such as plasmapheresis and peritoneal dialysis unnecessary.


Decreased capacity to metabolize diphenylhydantoin in a patient with hypersensitivity to warfarin. A 48 year old man with normal hepatic function presented with abnormally prolonged bleeding following orally administered warfarin. Warfarin and diphenylhydantoin are known to be hydroxylated in the liver. To investigate the possibility of the patient having a metabolic (hydroxylating) defect, his ability to metabolize diphenylhydantoin was studied, as it would have been unethical to administer warfarin again. Parallel studies were carried out on two healthy subjects as a basis for comparison. On three separate occasions the elimination half-life for diphenylhydantoin in the patient (158, 87, 72 hours) was significantly longer than those obtained in the normal subjects (31 and 32 hours). This difference was most probably due to decreased hydroxylation of diphenylhydantoin to 5-(p-hydroxy-phenyl)-5-phenylhydantoin since his urinary elimination of this substance was demonstrated to be significantly less than that of the normal subjects. The results suggest that this patient had a reduced capacity to hydroxylate diphenylhydantoin, and this defect in liver hydroxylation may explain his increased sensitivity to warfarin.


Candida thyroiditis--treated with 5 fluoro-cytosine. A case of Candida thyroiditis in a patient with Goodpasture's Syndrome is described. Factors predisposing to the infection were neutropenia and the concomitant use of antibiotics and immunosuppressive agents. The patient was successfully treated with 5 fluoro-cytosine (5 f-c) and surgical drainage.


Synchronous combined abdomino- thoraco-cervical (oesophagectomy). A synchronous combined abdomino-thoraco-cervical oesophagectomy with an abdominal and a thoracic team working simultaneously, is advocated. The method is described. The necessity for wide excision of the oesophagus is stressed, and the routine use of the stomach for reconstruction is advised. This approach may be used for both benign and malignant conditions.


Early gastric carcinoma.

Early gastric carcinoma. Seven cases of early gastric carcinoma are reported. This condition by definition refers to a carcinoma confined to the mucosa and submucosa only. The definition depends upon the depth of spread and not the surface area covered by tumour or the period over which it is believed to have been present. Each patient had a history indistinguishable from one of benign ulceration. All seven patients had barium meal studies, and in only two was the possibility of malignancy raised. In the other five patients the ulcers demonstrated radiologically were considered benign. Fibreoptic endoscopy was done in six cases; in three the appearances were suspicious of malignancy, and in the remaining three the lesions appeared benign. Biopsy specimens taken at endoscopy contained carcinomatous tissue in all six cases. The patients all had partial gastrectomy, and no recurrence has yet been found. The longest follow-up period is 36 months.


Large-bowel polypectomy via the colonoscope: experience with 80 polyps. The experience of two colonoscopy units in managing 88 patients referred with 114 suspected colonic polyps are presented. Almost a quarter of the suspected polyps were artefacts, while some actual polyps were not visualized at the initial colonoscopy. All but 10 of the confirmed polyps were successfully snared. Morbidity was low. Five of the polyps were malignant. The technical aspect of snaring and of setting up colonoscopy units are discussed. It is considered that colonoscopic polypectomy is the optimum management of colonic polyps.


A major advance in the management of pneumatosis coli. A new treatment for gas cysts of the large bowel is described which involves the continuous inhalation of a high concentration of oxygen over a five-day period. Two patients with incapacitating symptoms due to diffuse pneumatosis coli were treated by this method. Oxygen therapy resulted in remission of symptoms and disappearance of cysts in both cases. The physiological basis of this simple, effective therapy is discussed, together with the precautions necessary in its use.


Ileocaecal tuberculosis.

Ileocaecal tuberculosis. A retrospective study of 92 cases of ileocaecal tuberculosis, carried out at the Institute Hospital, New Delhi, is reported. The maximum incidence of the disease appeared to be between the ages of 20 and 40 years. There were 57 females and 35 males in the series. The majority of patients had symptoms for more than a year before they presented for treatment. Varying grades of intestianl obstruction constituted the usual clinical presentation, 44% of patients having subacute and 16% acute intestinal obstruction. Perianal fistula and abscesses were not seen. Most patients had no evidence of pulmonary tuberculosis. Barium X-ray studies were very helpful in the diagnosis. Bowel resection or short-circuiting gave very satisfactory results.


Hiatal hernia repair by posterior gastropexy. Posterior gastropexy was used in the repair of seventy-seven hiatal hermias from 1970 to 1975, after the fashion of Lucius D. Hill, of Seattle. The operations were performed by one author and reviewed by the other. The rationale and technique of the operation are discussed. Ten patients were lost to follow-up. Fifty-six patients were greatly imporved or cured, ten were imporved but still had some symptoms, while only one was unimproved. We conclude that posterior gastropexy is an effective, simple, and safe operation for the treatment of reflux associated with hiatal hernia.


Suggested new rules for exploration of the common bile duct at cholecystectomy. Traditional indications for exploration of the common bile duct have been made anachronistic by developments in operative cholangiography. A new technique of contact cholangiography, described in this paper, improves the precision of operative cholangiography and allows the traditional indications for exploration to be modified. A new set of guidelines for exploration of the common duct, based on high-quality operative cholangiography, is outlined, and the place of the supraduodenal and transduodenal routes for exploration is discussed. The results of the application of these policies in a series of 120 cholecystectomies are presented.


The use of a tongue flap for the repair of defects following radical surgery of the head and neck. Tongue flaps can provide up to 100 square centimeters of mucosal surface for the repair of defects in the oral cavity or upper pharnyx. They provide an acceptable alternative to the use of pedicled skin flaps for the repair of many small to medium sized defects which occur following radical cancer surgery.


Ovarian cysts in childhood.

Ovarian cysts in childhood. This is a review of cases of ovarian cyst encountered in childhood in the Manchester children's hospitals. The patients presented with acute or recurrent abdominal pain or an abdominal or pelvic mass. The commonest cyst found was a teratoma, which was discovered because of its size or because of a complication. All but one of the girls with teratomas had not reached puberty. After puberty the cysts were follicular or luteal in type, although there was one case of cystadenoma. Complications in the form of torsion, rupture which haemoperitoneum or haemorrhage into the cyst were common. Treatment consisted of ovarian cystectomy, oophorectomy or salpingo-oophorectomy, and the results were satisfactory.


Cerebral metastasis from melanoma.

Cerebral metastasis from melanoma. Fifty-seven patients suffering from melanotic cerebral metastases are reviewed. The nature and course of the primary lesion, the clinical history of the cerebral metastases and the results of treatment are discussed. Radiotherapy, chemotherapy, surgery and immunotherapy formed the basis of treatment.


Chondromalacia of the patella.

Chondromalacia of the patella. Where chondromalacia of the patella is resistant to conservative treatment, and where the existence of a Crooks ridge can be inferred from the clinical or X-ray findings, then an operative search for such a ridge, with trimming both of the ridge and of the affected area of the patella, offers a more promising surgical solution than other minor operative procedures, and a less drastic solution than patellectomy.


The natural history of osteoid osteoma.

The natural history of osteoid osteoma. A long-term follow-up of three patients suffering from osteoid osteoma who have not undergone surgery is reported. Only eight similar cases have been reported in the literature. It is shown that over a period of years the pain of osteoid osteoma eventually disappears but the radiological appearance may remain unaltered or gradually resolve. Surgical management of osteoid osteoma is advised because of the prolonged symptoms.


Fibromuscular hyperplasia of the iliac arteries. Fibromuscular hyperplasia is an uncommon disease of arteries with an unknown aetiology and an obscure natural history. It occurs rarely in the iliac vessels and may cause intermittent claudication. Two cases of fibromuscular hyperplasia of these arteries are reported. Both patients are middle-aged women. One presented with intermittent caludication and has been treated by aortofemoral bypass. The other is at present symptomless; the diagnosis was made in the course of the investigation of an abdominal bruit. Some features of the condition are discussed.


Ruptured iliac aneurysms.

Ruptured iliac aneurysms. Iliac aneurysms are uncommon as compared with aneurysms of the abdominal aorta. Rupture is the most serious complication of aneurysms of both vessels. Considerable attention has been focused on the management of ruptured abdomonal aortic aneurysms, but ruptured iliac aneurysms have received little notice. The problems in the management of ten ruptured iliac aneurysms, seen over the last five years, together with the rarity of other reports of this condition, have stimulated this review.


End thoracic duct presurres in man.

End thoracic duct presurres in man. Thoracic duct end pressures have been measured in a conscious patient undergoing cannulation in an attempt to remove serum blocking activity. Pressures were measured during rest, coughing, straining and laughing during the last-mentioned activity pressures of the order of 85 mm Hg were recorded. It is suggested that formal ligation of the cannula at the termination of treatment.


Cell proliferation and protein synthesis in human leukaemic myeloblasts after cytosine arabinoside therapy. The effect of a single intravenous bolus injection of cytosine arabinoside (ARA-C) on the cytokinetics and 3H-leucine uptake of leukaemic myeloblasts in bone marrow and blood was studied at intervals up to 96 h after ARA-C in five patients with previously untreated acute myelogenous leukaemia. An early decrease in mitotic index and in 3H-thymidine labelling was observed in four of five patients and pretreatment values were reached again within the observation period. Changes suggesting synchronization were not observed. ARA-C induced a marked decrease in protein synthesis in the leukaemic myeloblasts as estimated from either a decrease in the 3H-leucine labelling index or the mean grain count of 3H-leucine labelled cells. It is suggested that ARA-C is incorporated also by cell which are not in S-phase and has a prolonged biochemical effect on the leukaemic cells.


Hypersensitive reactions and antibody formation during L-asparaginase treatment of children and adults with acute leukemia. One hundred and fourteen patients with acute leukemia, 57 children (10 AML and 47 ALL) and 57 adults (37 AML and 20 ALL) were treated with L-asparaginase (Asnase) 200 or 1000 IU/kg daily for 30 days unless withdrawn on account of side effects. Combinations with other cytotoxic drugs were used in all but eight patients. Hypersensitive reactions, decrease in Asnase activity in plasma, and bivalent antibodies to Asnase appeared more frequently in adults (28%, 46%, and 79%, respectively) than in children (16%, 17%, and 25% respectively). There was a clear association between these three parameters. Thus hypersensitive reactions generally developed at the time of or after the decrease in plasma Asnase activity. Antibodies were detected only where Asnase activity had disappeared from the plasma. This time sequence, and in vitro experiments, suggest the formation of antigen-antibody complexes which might be responsible for inactivation of Asnase and for the development of hypersensitive reactions. However in many cases antibodies were found without concomitant enzyme inactivation or hypersensitive reactions. Antibodies to Asnase of IgE type (reagins) were found in only 10 children and 6 adults. There was no correlation between hypersensitive reactions, decrease in Asnase activity, and IgE antibodies. The frequency of remission among patients developing bivalent antibodies to Asnase was 68% (13/19) in contrast to 27% (3/11) among patients whose sera contained no detectable antibodies to Asnase, but the difference was not statistically significant.


Chromosomes and causation of human cancer and leukemia. XI. Correlation of karyotypes with clinical features of acute myeloblastic leukemia. Acute myeloblastic leukemia (AML) patients with chromosomal abnormalities in their bone marrow cells were divided into those with minor karyotypic abnormalities (MIKA) and those with major karyotypic abnormalities (MAKA). One of the largest subgroups in the MIKA group was shown to have cytologic characteristics typical of so-called "classical" AML and a "prototypic" karyotype, which has been shown to be due to translocation between chromosomes number 8 and number 21. A missing Y chromosome in AML was mostly associated with this karyotype. Patients of the MAKA group were usually erythroleukemic, had no or very few normal metaphases among the abnormal ones in the marrow, and almost invariably showed karyotypic instability. Karyotypic differences did not affect the patients' survival after the initiation of chemotherapy as much as did the presence or absence of normal metaphases. However, the karyotypes do appear to be relevant to the decision as to whether a patient should be administered chemotherapy when no normal metaphases are found on the initial bone marrow examination.


Serial observations on terminal deoxynucleotidyl transferase activity and lymphoblast surface markers in acute lymphoblastic leukemia. Terminal deoxynucleotidyl transferase activity and cell surface markers were measured in peripheral lymphoid cells from 27 children with acute lymphoblastic leukemia in various phases of their disease. Lymphoblasts from untreated patients had smooth surface ultrastructure but heterogeneous surface receptors. Greater than 60% of lymphoblasts from 4 to 7 untreated patients formed rosettes with sheep red blood cells. Transferase activity was variable, ranging from 8 to 210 units/10(8) blasts, but it was consistently elevated at diagnosis and in relapse. Transferase levels did not correlate with the presence of lymphoblast surface receptors. During induction therapy transferase activity decreased rapidly, but it remained elevated in peripheral lymphoid cells even when blasts were not detectable in peripheral blood smears. Patients in remission had normal surface receptors and undetectable or minimally elevated levels of transferase. Terminal transferase activity may be a sensitive biochemical marker for a primitive cell population and may be important in the evaluation of therapeutic effectiveness in acute lymphoblastic leukemia.


Some cases of Type III glycogen storage disease. Five patients with glycogen storage disease are described. Hypoglycemia was observed in all patients after an overnight fast, and glycemic and lactatemic curves obtained after oral administration of glucose or galactose were typical of those seen in Type III glycogenosis. An increase of liver glycogen up to 12-16% and complete absence of liver amylo-1,6-glucosidase were found in liver tissue samples obtained by needle biopsy. The patients were diagnosed as having Type III glycogenosis. In two patients the absence of amylo-1,6-glycosidase was accompanied by a sharp decline of liver phosphorylase activity. In one patient a decline of glucose-6-phosphatase activity was observed. The structure of liver glycogen was different in different patients, and so were the types of glycemic and lactatemic curves obtained upon protein tolerance tests. The above phenomena might be explained by some secondary disturbances in the activity of enzymes (phosphorylase, glucose-6-phosphatase) involved in the metabolism of liver glycogen of these patients.


Reliability of caries data in three clinical trials. The reliability of caries data obtained during three clinical trials is presented. Each of the three trials, conducted by different examiners, lasted 3 years and involved children aged 12 to 15 years. Reliability was quantified in terms of reliability coefficient and error variance, which allowed the effect of error upon the efficiency of each study to be measured. Reliability tended to be reduced when precaviation (initial) lesions were included in the DMFS count, but there was little difference between the reliability coefficients for each of four different surface-types. Error was more important in 3-year incremental rather than prevalence data, but nevertheless had a rather small influence upon sample size estimation or confidence limits of percent caries reductions.


Department of Community Dentistry, University of Florida College of Dentistry, Gainesville, Florida. The oral health status of 454 children and 115 adults from a population of migrant and seasonal farmworkers in Florida was assessed. The prevalence of disease among the children was consistent with that reported for other black children of this age. The migrants had received more dental treatment than the children of seasonal farmworkers; however, the level of care for both groups was strikingly low. The results of this neglect were clearly reflected in the mouths of the adults, most of which were found to be in a very deteriorated state of dental health. A program to cope with these long unmet needs is unrealistic. Efforts should be made to eliminate pain and infection until the cycle of poverty can be broken.


Alveolar bone loss in the permanent first molars of Norwegian schoolchildren receiving systematic dental care. A distance exceeding 2 mm from the cementoenamel junction (CEJ) to the alveolar bone was observed on the proximal surfaces of the first molars of proportionally more 15-year-olds (101 subjects) than 13-year-olds (99 subjects). The measurements were performed on bitewing radiographs, and the methodologic error amounted to 3%. Recordings in excess of 2 mm were most frequent (0.27 and 0.23) for the distal surfaces of the maxillary molars.


Periodontal condition in Turkish recruits. The periodontal condition of 300 Turkish troops was investigated using the modified Ramfjord Periodontal Disease Index. In addition, the gingival condition, presence and quantity of plaque and calculus, location and depth of periodontal pockets, tooth mobility, presence and severity of wear facets, diastema magnitude and the DMFT Index were determined. The average PDI was 3.8. Nearly 98% of the recruits suffered from gingivitis, 68% of whom exhibited moderate to severe inflammation without involvement of deeper structures. Moderate plaque accumulation and heavy calculus deposits were observed. An average DMFT of 5.09 was found. Little correlation was found between the relatively low DMFT rate and the Plaque Index.


Emergence of permanent teeth and onset of dental stages in the population of Iceland. The purpose of this investigation was to determine the mean ages at emergence of the permanent teeth of Icelandic children, as well as the mean ages at onset of the dental stages (DS). The material consisted of 1,941 randomly selected children, corresponding to 9.5% of the total primary and secondary school population of Reykjavik. The mean ages at emergence of the permanent teeth, along with the ages at commencement of DS 2, DS3, DS4 and DS M2, are given. Owing to the age distribution of the material, it was not possible to give mean ages at emergence of the first and third molars, or of the mandibular central incisors. A comparison of the emergence-ages in Icelandic children with those of Danish and Norwegian children showed close agreement.


Anti-caries effect of a 2% Na2PO3F-dentifrice in a Danish fluoride area. A 3-year experimental toothbrushing study was conducted in a natural fluoride area in Denmark to evaluate the anti-caries effect of a 2% sodium monofluorophosphate dentifrice. In a previous report the results for the total population of 1,407 schoolchildren, representing a broad age-span (7-12 years), at the commencement of the study in 1970 were given. In the present report results are presented for two subpopulations of "8-year-olds" and "11-year-olds" at the commencement of the study. Differential analysis of the effect of the test dentifrice on defined types of surfaces for the two subpopulations is given. The evaluation was performed using both the conventional DMF-indices and the recently published ECSI-Index6. The evaluation showed that the test dentifrice had a valuable anti-caries effect in both age groups, above and beyond the effect of the waterborne fluoride. Proximal surfaces were affected most baneficially by the active agent both in relative and absolute terms. However, an appreciable caries-preventive effect was also found on the "pit and fissure" surfaces.


Radioimmunoassay for human calcitonin employing synthetic calcitonin M: its clinical application. A sensitive and reliable radioimmunoassay for human calcitonin was described and applied to preliminary clinical studies. 125I-labelled synthetic human calcitonin M was purified by gel filtration with Sephadex G-25 and G-100. A nonequilibrium incubation system was applied at the final volume of incubation mixture of 500 mul, in which pooled plasma from normal subjects or hormone free serum was used as carrier protein at 20% incubation mixture. Dextran T 40 coated charcoal, resuspended in 1% bovine serum albumin buffer, was used for the separation of free from bound tracer. This showed the least nonspecific adsorption of tracer to charcoal. The assay was sensitive to 0.1 ng per milliliter of plasma. Recovery of synthetic human calcitonin added to plasma was found to be 101% (S. D., +/- 8). Diluted plasma from a patient with medullary thyroid carcinoma showed a dilution curve parallel to standards. Basal calcitonin levels were less than 0.3 ng/ml in normal subjects. Relatively high values were found in patients with chronic renal failure and in patients with malignant tumors. Extremely elevated values were found in patients with medullary thyroid carcinoma. Provocative calcium infusion tests were also performed.


[A change in hippocampal excitability in rabbits of different ages under the influence of serotoninergic system stimulation]. In adult, 6-10 days, and 16-20 days old rabbits with electrochemotrodes implanted into the left and right dorsal hippocampus, 5-methoxytriptamine (mexamine, 8 mg/kg, i.p.) stimulation of the central serotoninergic systems decreased the amount of seizures in the hippocampal penicilline epileptogenic focus in 6-10 and 16-20 days old rabbits and had no effect on interictal epileptiform discharges in the EEG. After i.v. mexamine administration (2 mg/kg) in 16-20 days old rabbits, both the inhibition of seizures and the interictal epileptiform activity in the EEG occurred. In adult rabbits, mexamine (2 mg/kg i.v.) had no effect on the hippocampus epileptogenic foci. The level of the serotoninergic systems activity is supposed to be more significant for supporting the hippocampus excitability in young rabbits than in adult ones.


Mucogingival repairs in periodontal surgery. The utilization of partial thickness apically repositioned flaps, laterally repositioned flaps, and free mucosal autografts enable the clinician to repair most mucogingival problems. These techniques may be used separately or in combination to increase the zone of attached gingiva, deepen the vestibular fold, and eliminate muscle and frenum pulls. If basic surgical principles are adhered to, the possibilities of repair of mucogingival problems utilizing these procedures are unlimited. The most important step in mucogingival surgery is planning the surgical procedure prior to beginning surgery. In this way different techniques may be combined to achieve the desired result and minimize the number of surgical episodes that may be required. It is important to conserve tissue. For example, tissues from gingivectomy or flap surgery in one area may be utilized for a free gingival graft in another area (Fig. 21). There is one last but most important requirement for mucogingival surgery: there should be some evidence of periodontal pathology. The lack of a wide zone of attached gingiva, the lack of a deep vestibule or a frenum pull is not in itself an indication for surgical intervention ulness some periodontal pathology is evident. In some cases it may be determined by the clinician's judgment that it would be best to perform a mucogingival surgical procedure to prevent one of these areas from developing into a periodontal problem. This decision is often dictated by the patient's age. In older patients, areas of minimal attached gingiva and shallow vestibular depth that show no periodontal breakdown should be regarded as areas of health and no surgical intervention is indicated. On the other hand, if these areas are evident in a child, particularly when orthodontic therapy is anticipated, then surgical intervention may be advisable to prevent serious damage to the gingival tissues.


Gingival recession. The condition, process, and treatment. The condition of gingival recession with its attendant patient complaints and additional professional concerns has been distinguished from the process of recession of the gingiva which has an obscure etiology. It has been suggested that the complaints and concerns regarding gingival recession be treated directly when they occur. Deviation from the expected anatomical form is not considered to be an excuse for therapy. The importance of the anatomical factors of alveolar bone dehiscence (long gingival fiber attachment) and lack of attached gingiva (absence of the fiber barrier) is not known. However, the current modailties of treatment have been examined in light of these hypotheses. Clearly, the effects of these anatomical factors on the process of recession of the gingiva need to be investigated.


Principles in periodontal osseous resection. In the clinical treatment of periodontal disease, the therapist should set definite goals so that he will know what to expect in a completed case. The goal of surgical intervention is certainly the elimination of the periodontal pocket. This is an obtainable objective. The therapist must understand normal periodontal morphology, thin margins, cone-shaped interdental papillae, and the interdental grooves blending into a harmonious periodontium. With this knowledge, he can surgically alter the tissue to achieve the desired architectural result. Restoration of the structures to healthy, maintainable contours is the ultimate success of his efforts. In many cases, osseous resection provides a mode of treatment that is predictable. It has become a basic procedure in periodontal therapy after more than 25 years of widespread clinical use by a large number of therapists.


Rationale for the lingual approach to mandibular osseous surgery. The definitive treatment of periodontitis for pocket elimination and the establishment of periodontal architecture that can be effectively maintained with daily personal oral hygiene techniques is sometimes an elusive goal. Performing osseous reduction, primarily from the lingual aspect of the posterior mandible, definitely helps in accomplishing such a goal. This paper should not be interpreted to mean that osseous correction of bony defects should be approached strictly from the lingual, since almost all cases require some buccal recontouring if a satisfactory soft and hard tissue architectural form is to be achieved. Clinical observation and experience have shown that the anatomical patterns, seen in relation to the mandible, have a powerful effect on normal periodontal architecture as well as the types and locations of bony defects encountered. Tooth to bone relationships deserve attention. The buccal housing of the alveolar bone is frequently thin in the premolar region and occasionally on the first molar, while the external oblique ridge causes thicknened bone over the second molar. The vestibular depth on the buccal of the molars is often quite shallow, meaning that only a very limited amount of osteoplasty-osteoectomy can be performed from the buccal. The lingual housing of the alveolar bone is normally thickened and shelf-like from the distal of the third molars to the mesial aspect of the premolar region. Because the posterior teeth are inclined lingually from the second premolar distally, the buccal marginal bone height is higher occlusally than the lingual bone margins, with the interproximal bone therefore sloping somewhat apically and lingually. Interdental craters are the most common defect seen with the onset of periodontitis. Such defects in the lower arch tend to occur beneath the contact areas of the teeth, which are much further to the lingual than in the maxilla. The highest percentage of interproximal craters are shallow and not amenable to grafting techniques in the hands of most clinicians. These shallow craters are prime candidates for osseous reduction techniques. With the progression of periodontitis, the interproximal defects frequently extend to include infrabony lingual defects. Although obtaining lingual access for osseous reduction techniques is often difficult, osteoectomy-osteoplasty techniques performed primarily from the buccal of the posterior mandible frequently result in compromise of the lingual and over treating the buccal in terms of osteoectomy procedures. The lingual embrasure spaces are usually wider than on the buccal, and with adequate reduction of the mylohyoid ridge, greater access for oral hygiene procedures is provided.


Osseous surgery--how much need we compromise? It is essential that the execution and results of osseous surgery be carefully analyzed. Perhaps the two most compelling reasons are (1) that we should understand the effects on tooth mobility and their implications for complex restorative dentistry, and (2) to facilitate the accurate assessment of postoperative "success," bearing in mind not only improvement of the environment, but also increased chances of survival for the operated teeth. We have discussed the effects of osseous surgery on tooth mobility. In the light of recent information, a more accurate assessment of the need for splinting can be made. There has always been some controversy about osseous recontouring. Of late, there has been a particular resurgence of scepticism as to the efficacy of osseous resective procedures compared with more conservative forms of therapy. Scientific investigation demands the doubting mind and the analytical approach in order to establish the truth or fallacy of current ideas. This approach is essential to the continued existence of periodontics as a clinical science. These investigations should be based on a full understanding of the therapeutic measures being investigated, as it is misleading to assess the results of a procedure when that procedure is either not used to its full advantage or inappropriately used. It is hoped that these comments will be helpful in deciding whether definitive osseous correction in a given case is desirable or possible, in terms of both bone removal and permanent splinting. The author also hopes that this article has served to enhance the possibilities of more complete osseous correction when indicated, in order to achieve minimal pocket depths, and to permit proper comparison with other modes of periodontal therapy. It is, however, crucial to realize that whatever modality of therapy utilized, it is merely one phase in the treatment spectrum. Maintaining a stable state for the patient over many years is the ultimate goal, beside which any given technical procedure pales in significance. Periodontal therapy is an ongoing process in which patient recall plays a central role.


The biology of human cells in tissue culture. I. Characterization of cells derived from osteogenic sarcomas. We have extensively characterized cell lines derived from six human osteosarcomas. The growth properties of these cultures were compared to those of fibroblastic cultures derived from skin of osteosarcoma patients and skin of bone-marrow of normal individuals. Each tumor-derived line showed some but not all of the abnormal growth properties usually associated with malignant transformation, indicating that tumor cells rather than normal stromal cells had in fact been cultured. The parameters measured included saturation density, cell morphology, growth pattern, growth on contact inhibited monolayers of normal fibroblastic or epithelial cells and tumorigenicity in immunosuppressed mice. Although the skin fibroblasts from the osteosarcoma patients appeared normal in vitro, they showed a greater ability to grow in immunosuppressed mice than did normalfibroblasts. This observation suggests that all fibroblasts of osteosarcoma patients may have an increased propensity for malignant transformation.


Clines in the colour polymorphism of Philaenus spumarius in Eastern Central Europe. Populations of Philaemus spumarius (Homoptera) have been investigated in the Baltic States of the USSR, in Czechoslovakia and in Hungary. Colour morph frequencies in these highly polymorphic populations are compared with those reported earlier from northern Italy. Gradual changes in allele frequencies (clines) transect the study area, which lies in the most central part of the range of Philaenus in Europe. From north to south the allele pM increases, but pO decreases, in frequency. In their distribution, some of the other alleles also showed regional gradients. The possibility that visual selection varies regionally is dismissed on indirect grounds. Gradients in climatic severity, or in other environmental variables changing concomitantly with climate, are regarded as the primary cause of the observed clines and other differences between regions.


Food induced esterase phenocopies in the snail Cepaea nemoralis. Hepatopancreatic extracts from the snail Cepaea nemoralis, assayed straight from the field, often contain three or four heavily staining esterase zones which migrate to the cathodal end of polyacrylamide disc gels during electrophoresis. Previous breeding results showed that the heavily straining zones appeared allelic but to incorporate these multibanded phenotypes, a super gene of five closely linked loci was tentatively proposed. Further breeding work again failed to demonstrate multiple zones in parents or offspring and so experiments were conducted to see whether the multi-zoned phenotypes in the wild were produced by secondary modification of single primary products. Wild snails yielding extracts containing more than two heavily staining zones were shown to possess only two such zones after three months under laboratory conditions. Also, the ingestion of nettle (Urtica dioica L.) has been demonstrated to induce extra esterase zones in laboratory-reared animals. Some of the secondarily induced zones appear identical in physical, biochemical and electrophoretic properties to the primary products of other alleles, and thus appear to be electrophoretic phenocopies. A model is suggested which could account for this phenomenon.


A sex-chromosome hybrid zone in the grasshopper Podisma pedestris (Orthoptera: Acrididae). Podisma pedestris exists as both an XO and neoXY form in the Southern French Alps. These chromosome types are shown to be contiguously allopatric and hybrid populations have been located in several places. Hybridisation appears to be occurring freely, but the hybrid zones are quite narrow. In several places the two distributions are separated by geographic barriers such as high mountain ridges and lowlands. The history of this XY chromosomal race is discussed in the light of the genetic dynamics of hybrid zones and the biogeography of this situation. Its origin is probably post-glacial, and it may be extending its range as a salient in one region. A comparison of the porperties of similar cases indicates that the formation of such chromosomal races may be a frequent event in relatively immobile species that are subjected to isolation and expansion by major climatic and ecological changes.


Control of normal differentiation of myeloid leukemic cells. X. Glucose utilization, cellular ATP and associated membrane changes in D+ and D- cells. Glucose utilization, energy metabolism and associated membrane changes, have been studied in D+ myeloid leukemic cells that can be induced to undergo cell differentiation to mature granulocytes by incubation with the appropriate conditioned medium (CM) and in D- myeloid leukemic cells that cannot be induced to differentiate to mature cells. Before incubation with CM, glycolysis and the glycolytic production of ATP were lower and the activity of the pentose cycle was higher in D+ than in D- cells. ATP depletion induced a higher degree of agglutination by concanavalin A in D- than in D+ cells, indicating a difference in their surface membrane. There were no detectable differences in the transport of glucose and the synthesis of sterols and fatty acids. After incubation with CM, the D+ cells, like normal granulocytes, showed a higher glycolysis, produced their ATP more through glycolysis than oxidative phosphorylation, became less dependent on the exogenous supply of glucose and oxygen and had a lower rate of sterol and fatty acid synthesis. The differentiating D+ cells also showed a change in their surface membrane resulting in an increased agglutinability without a change in ATP content and a stimulation of the pentose cycle by concanavalin A. These properties, which were not acquired by D- cells, were found before most of the D+ cells had differentiated to mature granulocytes. The data indicate, that the block in the ability of the D- cells to differentiate and the acquistion of the metabolic properties of normal granulocytes by differentiating D+ cells, were associated with differences in the organization of the cell surface membrane.


Folic acid binding protein in acute myeloid leukaemia. Folic acid binding protein was estimated in the serum of 94 control subjects and a normal range was established. Raised levels were found in folate deficiency and chronic myeloid leukaemia. Considerably raised levels were found in untreated acute myeloid leukaemia, most often in cases with a marked monocytic element.


Fluorescein angiography of free gingival autografts. The capillary blood circulation of free gingival autografts during healing was studied by means of 45 fluorescein angiographs taken over a postoperative period of 14 days in 10 female patients, 21 to 36 years old. The surgical technique commonly used for transplanting gingiva was slightly modified in that no surgical dressings and, in 3 cases, not even sutures were employed to immobilize the grafts. During the first 3 postoperative days, fluorescent plasmatic diffusion of increasing intensity was observed. In one case, fluorescing capillary circulation was detected as early as 24 hours after surgery, fluorescent capillaries became evident in all graft sites and increased steadily in number. Between 9 and 14 days after surgery, an even capillary loop pattern was established.


Plaque-free zones on human teeth in periodontitis. The surface morphology of the pocket area of extracted, periodontally involved, human teeth was studied with steromicroscope. A plaque-free zone was found to be present in all specimens. The width of the plaque-free zone was found to decrease as the pocket depth and loss of attachment increase.


The zone of completely and partially destructed periodontal fibres in pathological pockets. The morphology, the width and the appearance frequency of the zone completely and partially destructed periodontal fibres on human teeth were studied in the stereomicroscope. This zone was present between the most apical border of identifiable, epithelial attachment remnants and the most coronal intact periodontal fibres, and consisted of only a few fibres without any specific orientation. The mean width of the zone was 0.43 mm, and the appearance frequency almost 100%. The results of the comparison between clinical and laboratory pocket depths indicated that the pocket depths measured in the laboratory were always less deep than those recorded clinically. There seemed to be a relationship between these findings and the presence of a zone of completely and partially destructed periodontal fibres.


A radiographic study of the prevalence of chronic periodontitis in 14-year-old English schoolchildren. The prevalence of chronic periodontitis was investigated in six hundred and two 14-year-old English schoolchildren using a standardised radiographic technique. The interproximal spaces on the mesial and distal aspects of the first molar teeth were examined. Oral cleanliness and gingivitis for the anterior teeth and caries prevalence were also recorded. Radiographic evidence of chronic periodontitis was detected in 51.5% of the children examined. No significant relationship was demonstrated between bone loss associated with the first molars and any of the other parameters measured.


A radiographic method for assessing changes in alveolar bone height following periodontal therapy. A method is described for obtaining reproducible radiographs of several groups of teeth in the same jaw. The method was applied to assess changes in the alveolar bone height following periodontal treatment. An oral device was designed to permit direction of the central rays of the beam perpendicularly to the alveolar process in different parts of the jaws. The exposures were made at 60 kVp and 10mA, and standardized procedures were used for developing, fixing and rinsing the films. Alterations in the marginal alveolar bone level were determined in a stereocomparator system. The reproducibility of the method was determined. A pilot experiment was performed on 5 patients with periodontal disease. Following conservative treatment, including scaling and root planning, all patients were subjected to periodontal surgery, including alveolar bone denudation. Radiographs of the alveolar bone were obtained before and 2 months after the operation. By measuring in the stereocomparator parallaxes of both control points and points of the alveolar bone crest on paired radiographs, a mean decrease in interproximal alveolar bone height of 0.69 mm was found. Taking into account the small errors which are inherent in the method, this change in bone height could be regarded as a reliable measure of actual loss of bone.


The need for periodontal treatment in an urban population. The need for periodontal treatment was estimated in a group of the citizens of Oslo. A considerable treatment need was found in spite of the high dentist/population ratio in the area. The need for surgical treatment increased with age. Estimated treatment time was higher in males than in females.


Testing therapeutic measures for controlling chronic gingivitis in man: a suggested protocol. A protocol is presented for the clinical evaluation of agents used to control chronic gingivtis in man. Assessment is divided into three phases of increasing duration which are the initial screening of products over 1 month, the main gingivitis trial lasting at least 6 months and judging the effect of the product in preventing periodontitis which is extended for at least 3 years. The advances in data processing have made it possible to collect information separately on the three parameters of gingival inflammation.


The present status of the gingivectomy procedure. The use of the conventional gingivectomy procedure is indicated to achieve optimum gingival contour and to eliminate supra-alveolar pockets where these do not extend beyond the muco-gingival junction. The instrument of choice for the procedure is a gingivectomy knife. Where a blood-free field is required, electrosurgery may be used provided the instrument is not brought into contact with bone. The maintenance of good oral hygiene is essential.


Bone regeneration following damage by polysulphide impression material. A case report. Two days after polysulphide rubber impressions had been taken of gold inlay cavities in 6 and 7, a 22-year-old female dental student developed a painful swelling between 5 and 6. A radiograph revealed the presence of an irregular radiopaque body within the cancellous bone of the interdental septum between 5 and 6. At operation, 1 month later, the interdental septum was seen to have been destroyed and its position occupied by impression material and inflammatory tissue. When the lesion was reopened 2 years later to correct slight recurrent pocketing, significant regeneration of bone was found to have occurred.


Perceptual learning: its importance in dentistry. Perceptual skills are essential to the acquisition of motor skills in dentistry. The absence of these perceptual skills should be determined as early as possible and should be rectified by instruction. Programed instruction is one suitable method for teaching these skills. Perceptual discrimination will allow the learner to picture his goal or objective clearly, and it will increase his motivation by enabling him to reach this goal. Perceptual skills are necessary too for the learner to improve his performance by repetitive practice, see his mistakes, and institute corrective behavior.


Variables affecting attitudes of dentists toward the use of expanded function auxiliaries. A questionnaire survey of over 500 dentists in upstate New York was conducted to determine the following: (1) the extent to which the dentists understood the recent changes in the State Dental Practice Act as it applies to expanded functions of dental hygienists and (2) the attitudes and beliefs of these dentists regarding the use of hygienists and dental assistants in the performance of expanded duties in the private office. In general, the respondents were not familiar with the recent changes in the Dental Practice Act. When the respondents who employed dental hygienists were compared to those who did not employ hygienists, the differences regarding understanding of the changes in the act were not striking.


Systematic procedure for determining criterion scores. The present study describes a systematic method for determining a criterion score in criterion-referenced measurement. Reliable estimates were obtained by using only three judges who were subject matter experts. This demonstrates that the method can be applied to the test performance levels of individuals who are required to meet the objectives for a subject matter area. The present study showed that reliable judgments could be made even on subject matter of an advanced nature.


Educational value of a university-sponsored community dental clinic: a three year student evaluation. The overall assessment of the clinic experience by the students was positive. Response to the open-ended questions showed that a number of students took pride in the Venice clinic and that they gained a great deal of personal and professional satisfaction from being able to provide service to people in a low-income and minority community. Almost 90% stated that their understanding of health problems of the poor was improved; 75% felt that their ability to relate to patients from different backgrounds was broadened; and 45% expressed more willingness to practice in a low-income area. This community setting also enlarged the scope of the students' clinical experience. Over 50% saw pathological conditions that they had not viewed previously. In addition, over 90% of the students did at least 50% more work, and over half of these performed twice as much treatment.


To die young, to die old management of terminal illness at age 20 and at age 85: case reports. Death and dying in a 20-year-old woman. An effort was made to provide emotional support during the terminal phase of leukemia in a 20-year-old woman. Notable were the patient's own ways of coping and the responses of her family and the hospital staff. She first denied and then recognized her own dying. Her anger was prominent, and she withdrew from objects toward the end. The intense stresses in the doctor-patient relationship, transference, countertransference, and reality factors are described.


A practical questionnaire for predicting denture success or failure. The need and value to predict success and failure in treatment of denture patients are great. The psychological and emotional factors involved are just as important as if not more important than the oral and systemic findings. The value of a simple questionnaire for the edentulous and immediate denture patients has been presented. The authors believe that all schools should present advanced information on the psychological aspects of dental care.


Self-image and its relation to denture acceptance. A study was initiated to determine whether a relationship exists in geriatric patients between self-image and the extent of their denture acceptance. Three assessing instruments were employed, namely, a "Focused Interview," the embedded-figures test, and projective figure drawings. Scores obtained were compared with scores on the Denture-Acceptance Rating Scale. The research results derived from the data follow: 1. Comparison of the degree of denture acceptance with the scores on all three assessing instruments showed significant relationships. Therefore, the hypothesis under study was accepted. 2. The "Focused Interview" appeared particularly well suited to a geriatric population, because it was nonthreatening, provided a communication outlet, and can be readily employed by a practitioner. 3. The embedded-figures test and the projective figure drawings appeared less appropriate for this population because of factors such as psychomotor retardation, perceptual difficulties, and diminution of ego strength which accompany the aging process. 4. The men in this study appeared to accept dentures more readily than the women, manifested higher morale, and were more field-independent. 5. Employed subjects, as compared to unemployed, showed significantly greater denture acceptance, higher morale and self-image, and a greater degree of field-independence. These factors appeared related to greater flexibility of adaptation. 6. Socioeconomic factors appeared to be significantly and positively related to morale factors. 7. Complaints regarding dentures were largely of a physical nature. They appeared to relate primarily to difficulties with adjustment to the new artifact which represented an alteration of body image for the subjects. 8. The study provided corroborative evidence of the need for the dentist to make an initial assessment of those personality factors in his patients which might limit his ability to provide adequate dental services.


Comparing ridge resorption with various surgical techniques in immediate dentures. The three surgical techniques of simple tooth extraction and labial plate and intraseptal alveoloplasty were compared. The results were confirmed by statistical analysis. The conclusion of this study clearly indicated that simple tooth extraction is the best surgical approach to be followed to preserve as much of the residual alveolar ridge as possible.


Tissue pressure under complete maxillary dentures. This preliminary report has shown the following interesting points: (1) Measurements of tissue pressures beneath dentures are possible using the Sanborn 350 recorder. (2) Stable dentures produce high pressures on the supporting tissues and transmit these pressures from region to region, varying with how the patient uses the dentures. (3) Most often, an opposite large or negative pressure immediately followed the production of positive pressure at the same site beneath the denture. Thus, each movement actually traumatizes the tissue twice. (4) Nonmasticatory pressures produced under dentures are as great as or greater than masticatory pressures. (5) Wave forms for each biting maneuver or sound produced can be charted and are typical for each patient, probably representing denture movement. (6) Swallowing unassociated with eating or drinking produced very high positive and very low negative pressures, giving the greatest ranges of pressures recorded in this experiment. (7) Smoking (recorded in only one patient) also produced a great range of pressures. (8) Sticky foods such as cheddar cheese produced greater negative pressures than the other foods tested. (9) The one patient with natural teeth opposing his denture gave much more uniform and lower pressures than did the patients with complete dentures. (10) This method allows visualization of pressure movement under dentures. The effect of these continually occurring, nonmasticatory, induced pressure changes and pressure waves beneath the dentures may well be of greater significance than that of mastication.


Extracoronal amalgam restorations utilizing available tooth structure for retention. The rationale and technique for an alternative to placement of pins for retention of amalgam restorations have been presented. The non-pin-retained extracoronal amalgam provides a permanent restoration, capable of fine marginal adaptation, natural contour, excellent occlusion, and remarkable durability.


Morphology of gingival capillaries adjacent to complete crowns. Clinically normal gingivae adjacent to natural teeth did not exhibit dilated capillaries. The morphologies of the capillary loops were of the normal and mixed types. More than one fourth of the capillary loops in the gingivae adjacent to the complete crowns showed dilatation. The capillary loops were of the mixed and complex forms. Dilatation and complex capillary loops were found in the clinically normal gingivae adjacent to the complete crowns. The capillary microscope is an aid in the diagnosis of gingivae adjacent to complete crowns.


Pulp reaction to a temporary zinc oxide/eugenol cement. The pulpal irritation, such as inflammatory reaction and aspiration of pulpal cells, demonstrated after insertion of the zinc oxide/eugenol cement (Nobetec) seems to warrant the following recommendations: (1) A temporary restoration with a zinc oxide/eugenol base should not be inserted in deep cavities without a protective liner or a calcium hydroxide base covering the exposed dentinal tubules. (2) Before the temporary cementing of inlays and crowns with a zinc oxide/eugenol cement, not only should the dentin be properly cleaned and debris removed, but the prepared surfaces should be covered with a calcium hydroxide liner.


Rehabilitating dentulous hemimandibulectomy patients. A hemimandibulectomy can have many debilitating consequences, such as an eccentric occlusion, a disoriented masticatory cycle, facial disfigurement, distorted speech, and salivation problems. If prosthetic treatment begins some time following surgery and the cicatricial tissue has already consolidated, additional treatment time is necessary. A technique is described which combines crowns with a maxillary prosthesis to guide the mandible into a functional occlusion.


Examination forms for edentulous patients--a survey. Examination and diagnosis forms for edentulous patients from 46 dental colleges in the United States were used in this study. Selected data were taken from each form and compiled under four general and 15 specific entries. Some college forms use entries requiring few and succinct responses,while other forms use entries requiring many and detailed responses. It appears that a correlation does exist between the thoroughness of the examination form and the proficiency of the dental student rendering complete denture therapy. Stated in a positive manner, this survey of college complete denture examination forms suggests that most dental students: use a separate complete denture form for the examination and diagnosis; ask for the chief complaint of the patient; ask one to four questions on past dental history; record 10 to 19 entries relating to oral anatomy; record one to four entries relating to oral physiology; record the mental attitude using two to four descriptive terms; and record one prognosis. Stated in a negative manner, this survey of college complete denture examination forms suggest that most dental students: do not examine the present complete dentures worn by the patient; do not use oral diagrams to show unfavorable or abnormal areas; do not ask for a prognosis in two or more areas; do not ask if the patient wears complete dentures at night; do not ascertain the attitude of the patient after receiving complete dentures; do not ask questions on complete denture expectations; do not use an interview form; and do not work with a staff dentist who has a psychology degree. The intent of this study is to create a spectrum of awareness concerning the presence or absence of specific information on the examination forms. Complete denture examination forms would be more beneficial to the dental student if they provided a high quality of pertinent clinical information. This information would aid the dental student in making an intelligent diagnosis, treatment plan, and prognosis.


Some substituted naphthazarins as potential anticancer agents. Some 2,3-bis(substituted methyl)naphthazarins and related compounds were synthesized by the Diels-Alder reaction of benzoquinone and 2,3-dimethylbutadiene followed by oxidation and substitution reactions. These compounds were prepared as potential biological alkylating agents. Screening results indicated that 1,4-diacetyl-6,7-dimethyl-4a,5,8,8a-tetrahydronaphthalene and 5,8-bis(benzoyloxy)-2,3-dimethyl-1,4-naphthoquinone possessed borderline activity against leukemia P388 and that naphthazarin diacetate possessed confirmed cytotoxicity against the cell culture of human epidermoid carcinoma of the nasopharynx.


Tics following methylphenidate administration. A report of 20 cases. Among children receiving methylphenidate hydrochloride, tics developed in 14, and in six children with pre-existing tics, the tics became worse. The clinical diagnosis in 19 cases was minimal brain dysfunction (MBD), and in one case, Gilles de la Tourette syndrome. Duration and dose of medication showed no particular pattern. In only one case did tics persist unchanged after methylphenidate treatment was discontinued. Tics related to methylphenidate administration appear to be rare (20 of 1,520 cases, or 1.3%) and may point to a specific susceptibility possibly related to personality profile (obsessive, perseverative, withdrawn).


Physical aspects of automatic respirators. Objective of artificial ventilation is to maintain sufficient gas exchange with the lowest degree of mechanical burden to the lung that is possible. The basic principle of IPPV is a pressure gradient between the upper airways and the alveoli during inspiration, thus creating a positive gas flow to the lungs. Different technical arrangements can be chosen to overcome the resistances of the lung, depending upon whether the flow or the pressure is the underlying parameter for artificial ventilation. The driving system can be either compressed gas from a pipeline or an electrically driven pump or compressor. With the direct acting generator, the force of the driving mechanism directly inflates the lung, whereas the indirect acting generator has flexible coupling element between pump and patient. The switchover from inspiration to expiration is determined by the cycling parameter, uhich can either be the pressure, the flow, the volume or the time. The mode of cycling influences the reaction of the respirator to changing lung conditions. Only the volume and time cycled types maintain a constant ventilation volume with changing lung resistances. Lastly, the different behavior of respirators during expiration is discussed. An active support of expiration by means of a negative pressure has less meaning nowadays. On the other hand, a positive end expiratory pressure (PEEP) has turned out to be a very helpful tool in long-term ventilation.


Genital herpes simplex in the female 1968 to 1973. One hundred and twenty-nine female patients with genital herpes simplex infection are considered. Diagnosis and management are discussed, and the importance of excluding other sexually transmitted diseases is emphasised.


Coronary risk factors in New Zealand Maori and European adolescents: The Rotoua Lakes Study 2. A survey if 298 adolescents was carried out by questionnaire, medical examination, anthropometric and biochemical methods, to determine the prevalence of risk factors for coronary heart disease particularly those that might explain the known difference in atherosclerotic mortality between European and Maori women. Data on blood pressure, obesity and serum lipids are presented here, and are discussed together with smoking and serum uric acid. Obesity, hypertriglyceridaemia, smoking and hyperuricaemia all contributed to a higher coronary risk status for Maori subjects.


Verapamil and the heart: Pharmacological and Therapeutic Considerations. Verapamil is a new anti-anginal and anti-arrhythmic drug whose pharmacological actions can be related to its specific blocking effect on the transmembrane transport of calcium ions. Intravenous verapamil slows the ventricular rate in atrial fibrillation and flutter with an occasional patient reverting to sinus rhythm. The drug promptly terminates most cases of paroxysmal supraventricular tachycardias. It is likely to become the initial agent of choice in the acute treatment of this arrhythmia. Verapamil is not effective in ventricular tachycardia or in atrial fibrillation complicating the WPW syndrome. Few side effects are encountered following intravenous verapamil expecially when the drug is given slowly. Verapamil is also effective in angina in a dose of 120mg tds orally. Little is known of the metabolism and pharmacokinetic of verapamil but the available experience in arrhythmias clearly justifies further study.


Acute renal artery occlusion.

Acute renal artery occlusion. Eeven cases of acute renal artery occlusion are reviewed. The clinical presentation and features of the condition are discussed and reasons for delays in diagnosis are examined. Two cases in whom active treatment was carried out are described in detail. Acute renal artery occlusion is most common in patients with severe cardiac disease and this may influence decisions on treatment.


Pregnancy and von Gierke's disease.

Pregnancy and von Gierke's disease. A detailed description of the course of pregnancy in a patient with von Gierke's disease is presented. Careful dietary control together with proper management of the hematologic complications of the disease led to a successful outcome.


[Amylo-1,6-glucosidase--an enzyme determining the rate of glycogenolysis in teleost embryos after fertilization]. The activity of amylo-1,6-glucosidase (EC 3.2.1.33 dextrin: 6-glucohydrolase, "debranching enzyme") in the loach embryos is localized mainly in the blastoderm. On the basis of correlation between the increase in its activity and in the content of hexose monophosphates during embryogenesis, a suggestion is put forward to the effect that the rate of glycogenolysis is controlled by the activity of this enzyme.


A technique for open reduction of subcondylar fractures. Described is a safe and efficient technique for open reduction of the subcondylar fracture. The technique utilizes a Risdon incision to expose the fracture site and a stab incision in the preauricular region. A University of Tennessee drill guide or bone screw is introduced through the stab incision to facilitate placement of drill holes in the fragments, threading of the transosseous wires, and repositioning of the condyle within the fossa.


Correction of mandibular dentoalveolar retrusion by anterior segmental advancement. Mandibular anterior segmental advancement offers an alternative mode of management for certain patients with Class II dentoalveolar malocclusion. The procedure is ideally indicted in paradoxical occlusal situations wherein Class II malocclusion is associated with a prognathic profile or when total body advancement would produce an unacceptable occlusion or profile. Arch expansion and augmentation genioplasty may be achieved by tailoring the surgical approach. Complications were minimal in the cases presented. Since arch lengthening results, the potential food table is increased, necessitating either fixed or removeable prosthetic care.


Chrome cobalt and gold implant for the reconstruction of a traumatized orbital floor. Diplopia and enophthalmos were two sequelae of injuries to the orbital floor. These have been corrected by chrome cobalt and gold implants in the reconstruction of the orbital-floor defect after the inferior rectus and inferior oblique muscles and the orbital structures were freed from the area of blowout. An infraorbital approach was used for access.


A rare local anesthetic misadventure. Case report and anatomic considerations. When the mouth is fully opened, the depth to which the needle is inserted need not be great in order to pass through the submandibular gland capsule, and insertion of the needle behind the second molar tooth would result in passage behind the posterior border of the my-ohyoid muscle. The discussion indicates the relative ease with which fluid may penetrate the parapharyngeal space, particularly if pressure is used in injecting. Fluid diffusing into the region of the carotid triangle may have been responsible for the various symptoms, and anesthesia of the hypoglossal nerve, nerve, thyrohyoid nerve, internal and external laryngeal nerves, and carotid body possibly occurred. Anesthesia of the vagus is a remote possibility.


Patient motivation and response to surgical correction of prognathism. Twenty-five patients operated upon between 1969 and 1973 for correction of mandibular prognathism were recalled in 1975 and asked to evaluate their attitudes toward the procedure and the postoperative results. All but one were satisfied with the results. Postoperative numbness of the lip and chin lasting more than 6 months was commonly noted following the intraoral sagittal split method. This did not influence the patient's satisfaction with the operation. The minimal postoperative scar following the extraoral oblique osteotomy was not a negative factor. Most patients underwent the surgical procedure for esthetic reasons. A large number (68 per cent) noted a change in personality postoperatively. A rationale for selective preoperative psychologic counseling is suggested.


Metastatic neuroblastoma in the mandible. Report of a case. The case reported here is that of a metastatic neuroblastoma of the mandible in a 5-year-old boy. This kind of metastasis in the mandible is very rare. Osteolytic jaw defects and unexplainable looseness of the deciduous molars in children should induce a thorough examination with the possibility of a metastatic malignoma in mind. A summary of the literature and prognosis of these tumors has been given.


Oral lesions in psoriatic patients.

Oral lesions in psoriatic patients. Psoriasis  is a chronic, recurrent, inflammatory disease of the skin. The occurence of psoriatic lesions in oral mucous membranes is a subject of controversy, and some investigators have stated that such lesions do not occur at all. In the present investigation 100 psoriatic patients were examined for the presence of oral lesions. No patient exhibited oral lesions of psoriasis; however, there was a relatively high incidence of angular cheilosis (11 per cent), fissured tongue (6 per cent), and benign migratory glossitis (5 per cent). The possibility that benign migratory glossitis is an oral manifestation of psoriasis is discussed.


Hand, foot, and mouth disease.

Hand, foot, and mouth disease. Hand, foot, and mouth disease, also known as vesicular stomatitis with exanthem, is a vesicular disorder affecting both skin and oral mucosa. The disease is usually caused by Coxsackie virus A-16 and affects mainly children. The oral lesions may require differential diagnosis from other conditions, such as herpetic gingivostomatitis, aphthous stomatitis, and herpangina. Hand, foot, and mouth disease should not be confused with foot-and-mouth disease of cattle, which is rare in human beings and is not caused by Coxsackie virus.


The nonkeratinocyte intraepithelial cell population in lichen planus. An ultrastructural characterization of cells in gingival lesions. Lesions of gingival lichen planus were studied ultrastructurally to determine the types of cells, other than keratinocytes, present within the epithelial layer and the relationship of these cells to each other and to the keratinocytes. Cell types identified included small and medium-sized lymphocytes, macrophages, mast cells, and Langerhans cells. Some cells lacked sufficient specific features to permit definitive identification. The cells were found either singly or in groups. Generally, some alteration in the intercellular spaces between keratinocytes was apparent, even in regions where the mononuclear cells were absent or in the process of crossing the basal lamina. Most of the mononuclear cells had cytologic features which indicated that they were active cells. Occasionally lymphocytes appeared, on a morphologic basis, to be interacting with adjacent keratinocytes.


Electron microscopic study on the pathogenesis of recurrent aphthous ulceration as compared to Behçet's syndrome. In the prickle-cell layer of the oral epithelium of recurrent aphthous ulceration (RAU) the reticuloid cells with homogeneous, electron-lucent nuclei were attached to the degenerated prickle cells and ingested the cytoplasm of the prickle cells. The reticuloid cells came in contact with small lymphocytes, to which the immunologic information was transferred, inducing them to undergo blast transformation. Lymphoid cells, corresponding to T-cells, may produce a cytotoxic factor, since the prickle cells ultimately undergo degeneration. These changes are consistent with those of delayed hypersensitivity reactions. The cytoplasm of prickle cells apparently acts as an autoantigen. In Behçet's syndrome the macrophages were encountered in the epithelium. Other consequences were quite similar to those of RAU. The nucleus of the macrophage is more electron dense and has condensed chromatin along with the nuclear membrane. This can be a difference between Behçet's syndrome and RAU only at the initial stage of the diseases.


Eosinophilic bodies in the epithelium of oral inflammatory hyperplastic lesions. Histopathologic and histochemical study. Four hundred twenty-three specimens of inflammatory hyperplastic lesions of the oral cavity were examined for changes in the epithelium. Amorphic eosinophilic material was found in the superficial layers of the epithelium in 12 per cent of the cases. The incidence and severity of the changes were related to the intensity of the inflammatory reaction in the underlying tissue. Histochemically, the material contained protein, disulfide and sulfhydryl groups, tryptophan, and carbohydrate.


Facial and oral manifestations in leprosy. An evaluation of seventy cases. A clinical and radiologic study of early and late manifestations in tuberculoid, dimorphous, and lepromatous leprosy was undertaken in order to determine characteristics, occurrence, and incidence of facial and oral lesions. Dermal, mucosal, neural, skeletal, and dental changes were correlated with the duration of leprosy, duration of treatment, and age of the patient.


Taurodontism. Report of sixteen cases in Israel. Taurodontism is generally considered a very rare dental anomaly in modern man. Sixteen new cases of taurodontism in Israel are described in patients presenting for routine treatment in a dental center. The majority of affected teeth occurred singly, and the mandibular second molar was the tooth most frequently involved. It would appear that taurodontism is a great deal more common than was previously thought. The clinical aspects of the condition are discussed with regard to endodontic and periodontal therapy.


[Eosinophilia in the preleukaemic phase of acute granulocytic leukaemia (author's transl)]. The pathogenesis of a marked eosinophilia in the preleukaemic phase of an acute granulocytic leukaemia is described and discussed. An otherwise symptom-free girl 4 years of age, presented with a transient increased WBC count with eosinophilia during one year before onset of acute granulocytic leukaemia. All relevant tests for explanation of this eosinophilia proved negative. The phenomenon of transient eosinophilia with successive onset of acute granulocytic leukaemia may fit into the concept of immunological control of tumorgenesis. In the present case it is suggested that the initial eosinophilia was the manifestation of the body's fight against the first malignant leukaemic cells. Finally the immunological defence was overwhelmed and the eosinophilia disappeared with concomitant appearance of leukaemic cells.


[Differential diagnosis of chronic myeloic leucemia in infancy (author's transl)]. A 3 months old girl presented with significant enlargement of liver, spleen and lymphnodes, with moderate anemia, thrombopenia and leucocytosis. In the differential count there was a shift to the left and an increase of monocyte-like cells (35%). Differential diagnosis included leucemoid reaction, infectious mononucleosis, myelo-proliferative disorder with a missing C chromosome and chronic myeloid leucemia. Clinical symptoms, cytochemistry and caryotype of bone marrow cells suggested infantile chronic myeloic leucemia and normal ALP index and possibly normal HbF. Treatment with 6-mercaptopurine was followed by partial remission. The therapeutic consequences of exact differential diagnosis are discussed.


[Dental instrument as foreign body in the air-passage]. A case report on a Kerr-broach aspirated to the left bronchial tree is presented. The broach was removed with difficulties using bronchoscope and forceps. The use of rubber dam is advocated in endodontic therapy. A scheme to handle foreign bodies in the bronchial tree is outlined involving immediate X-ray and removal by an experienced endoscopist.


Leukemia allotransplants in canine fetuses: influence of host age and immune responsiveness. Myelomonocytic leukemia cells allografted prenatally in some developing purebred Beagle fetuses elicited tumors postnatally in some of the pups. The later in gestation that the inoculum was delivered, the less was the disposition to eventual leukemia, indicating that fetal host age at the time of grafting and tumorigenesis are correlated. The leukemogenic transplants may have grown because of fetal immunoinsufficiency or because they were tolerogenic in the developing immune system. Limited immunologic data for exclusion of the latter possibility are reported.


Amantadine decreases d-amphetamine stimulation and increases d-amphetamine anorexia in mice. Amantadine hydrochloride (Symmetrel), an antiviral, antiparkinson agent that is most frequently used clinically at oral doses of 2 to 3 mg/kg, significantly decreased d-amphetamine-induced CNS stimulation (motor activity) and simultaneously increased d-amphetamine-induced anorexia (milk intake) in mice. Amantadine did this at oral doses of 2.5 and 5 mg/kg, which alone had no effect on either motor activity or milk intake.


The resistance of sheep to Fasciola hepatica: studies on the pathophysiology of challenge infections. Determinations of circulating eosinophils, plasma proteins and glutamate dehydrogenase, voluntary drymatter intake, and plasma loss in the faeces were carried out on three groups of sheep infected with Fasciola hepatica. One group was previously uninfected, one had been treated to eliminate a 15-weeklong preliminary infection, and one had previously been exposed to five infections each terminated after one week. Compared with the controls, both challenged groups showed earlier and greater peaks of eosinophils and the group previously exposed to multiple short-term infection showed a more gradual and persistent rise in glutamate dehydrogenase. The trends of plasma globulin suggested that an anamnestic response occurred only in the group which previously harboured adult flukes. The latter group also showed, at 12-14 weeks after challenge, the lowest intake of dry matter and the greatest loss of plasma in the faeces. At post mortem examination, similar numbers of flukes were recovered from challenged and control sheep. It was concluded that there was no evidence from the present experiment to show that preliminary infection of sheep with F hepatica conferred any significant resistance to the physiological effects of a challenge infection.


Familial leukaemia. A report of three cases of acute leukaemia in a Brazilian family. The authors reported of three individuals observations -- three siblings in a family -- of acute lymphoid leukaemia. Cytogenetic studies carried out in peripheral blood, lymphocyte cultures with PHA, in two patients and in several relatives, showed numerical and structural alterations. The third patient died before the cytogenetic studies were done.


Leukocytosis and fibrinolytic activity of the blood in leukemic patients. The relation between the levels of leukemic leukocytosis and blood fibrinolytic activity was studied in 58 patients with acute leukemia, 58 with chronic granulocytic leukemia, and 60 with chronic lymphocytic leukemia. In all these groups, high levels of leukemic leukocytosis were associated with increased blood fibrinolytic activity. Differences between patients with high and low values of leukocytosis were statistically significant.


The predominant cultivable organisms in juvenile periodontitis. Quantitative and qualitative examinations of the predominant cultivable microflora of the advanced tissue destruction (pocket) associated with juvenile periodontitis and of control pockets without loss of attachment were carried out by using anaerobic tube culture technique. The microflora from the control sites consisted primarily of streptococci, Gram-negative rods, and Gram-positive rods. In contrast, the test pockets had a relatively stable and characteristic microflora, dominated by various Gram-negative, anaerobic rods. The Gram-negative rods were divided into main groups, but a satisfactory classification of many of these microorganisms could not be performed with the methods used and the data available. The predominating Gram-negative rods differed from individual to individual. The role of the Gram-negative rods in the etiology of juvenile periodontitis is unknown. Some potential pathogenic mechanisms of these microorganisms are discussed.


Periodontal health following fibrotomy of the supra-alveolar fibers. A clinical follow-up study has been carried out in order to study the periodontal health of orthodontically derotated teeth where the supra-alveolar fibers have been severed by an incision through the bottom of the marginal pocket to the border of the alveolar bone in order to reduce the tendency towards a posttreatment relapse. The material consisted of 30 rotated teeth treated orthodontically in 27 patients between the ages of 9 and 22 years. Following an average retention period of 8.3 months, the supra-alveolar fibers were severed down to the alveolar bone border. The control material consisted of untreated, banded contralateral teeth in the same jaw. The patients were examined for plaque, gingival health and depth of the marginal pockets. No significant difference in periodontal health could be found on comparison between, on the one hand, teeth treated with fibrotomy and, on the other hand, untreated teeth.


Haemophili in developing dental plaque.

Haemophili in developing dental plaque. Evidence for a possible role played by oral haemophili in the development of dental plaque was sought by studying the occurrence of these bacteria in early dental plaque of smooth surfaces and occlusal fissures in six dental students. The mean number of haemophili per 10(3) anaerobes in early smooth surface plaque (18 h) and fissure plaque (7 d) was 95 and 22 respectively. Examination of 988 Haemophilus isolates revealed that H. parainfluenzae was the only species in samples of fissure plaque, whereas some samples from smooth surfaces, in addition to the predominating and ubiquitous H. parainfluenzae, yielded growth of the two species H. segnis and H. aphrophilus. It is concluded that haemophili are among the primary colonizers of smooth surfaces of teeth.


Effect of formaldehyde-containing drugs on human dental pulp evaluated by enzyme histochemical technique. The in vivo effect of formaldehyde on pulp tissue in short-term studies cannot be established by using routine histologic techniques because the tissue is exposed to a fixative in vivo as well as during the histologic preparation. The pulps of permanent premolars were amputated and zinc oxide with 4% formaldehyde or formocresol was used as wound dressing. The observation periods varied from 1 to 16 d. After extraction the teeth were freeze-sectioned, freeze-dried and then incubated for histochemical demonstration of some oxidative and hydrolytic enzymes. A demarcated border between apically stained and cervically nonstained pulp tissue was found in sections incubated for oxidative enzymes. When formocresol, which has a high concentration of formaldehyde, was used, the border was situated closer to the apex. This was also the case when the observation period was increased. The incubation for lactate dehydrogenase gave a high staining intensity. Thus the use of frozen sections in combination with the histochemical method for the demonstration of lactate dehydrogenase appears to be suitable for the study of the penetration of formaldehyde in pulp tissue in short-term studies.


Deformation of cavities and resin fillings in loaded teeth. The purpose of the present work was to study (1) the deformation of selected types of cavities in axially loaded human teeth and (2) the possible effect of this deformation on the restorative quality of fillings in the cavities. Recently extracted wet teeth without any visible structural defects were used throughout the study. Standard Class III and large Class III cavities were prepared in maxillary incisors, while Class I, m-o, m-o-d, and Class V cavities were made in maxillary first premolars. For the second part of the study several of the cavities, etched of non-etched, were filled with restroative resins. Mounted in a measuring microscope the teeth were loaded in a way simulating biting or chewing; cavities with fillings were accepted only when no marginal gaps could be found. The results showed a deformation of empty cavities proportional to the load up to 16 kg, the decrease or increase in diameter being 0.1-1.0 mum/kg, depending on the type of cavity. Loading and unloading of teeth with filled cavities resulted in permanent or transitory gaps. The dimensional instability of cavities in loaded teeth indicates a severe risk of percolation by several restoratives and of marginal fracture of brittle fillings.


Non-random and random chromosomal abnormalities in transformed chronic granulocytic leukaemia. Chromosome abnormalities, identified using a banding technique and additional to the Ph, are reported in 10 consecutive cases of transformed chronic granulocytic leukaemia. In most of the cases the abnormalities were non random. In 2 cases serial studies were performed and additional abnormalities found, antedating transformation by one week and two months respectively. In 2 others the Ph status had been established during the chronic phase of the disease. In the remaining cases the first chromosome analysis was performed at the time of transformation.


[Proceedings: Home care in chronic respiratory insufficiency. Indications for the prescription of a home respirator, its various types and possibilities for use]. Justified doubts exist in regard to the effectiveness of a long term home care plan for patients with stable chronic obstructive lung disease (COLD), especially when intermittent positive pressure breathing (IPPB) home care is advocated. Conclusive long term studies are lacking, however. In conjunction with all other possibilities offered by a well organized home care plan, IPPB still appears to be an appropriate therapeutic adjunct in the form of regular airway cleaning 3-6 times per day. This entails repeated inhalations of an aerosol with bronchodilator and surface active humidifier, frequently repeated mobilization of mucus and expectoration, deepening of tidal volume with increase of alveolar ventilation, and consequent amelioration of the arterial blood gases and pulmonary arteriolar resistance. Two simple home care respirators may be useful in carefully selected and cooperative patients with stable COLD and chronic respiratory failure: 1. the Fluidic-Assistor, which is automated, simple to use and sterilize, and inexpensive, but noisy and difficult to adjust for pressure and flow by the patient; 2. the Monaghan 515, which is automated, fully adjustable for pressure and flow by the patient, quiet and of pleasing design but difficult to handle and expensive. A preliminary study of the Minibird 2 with apneustic flow time regulation has been performed with five stable COLD patients. A positive end-inspiratory pressure of 20 cm H2O, an inspiratory time of 3+/-0.5 sec and an apneustic flow time of 1.5+/-0.5 sec were used. An 20 mm Hg fall in blood pressure and additional arterial hypoxemia seemed to be due to a decrease in cardiac output. Also, apneustic flow time did not significantly increase the FEV1 and is therefore not recommended for home care.


[Proceedings: The cooperation of welfare institutions]. In the light of developments in the Canton of Berne, an account is presented of the expansion of the cantonal antituberculosis leagues, their welfare offices and parent institution, the Swiss Antituberculosis Association. Special attention is drawn to the activities of these organizations in the case of other longterm diseases such as chronic obstructive bronchitis, chronic bronchial asthma and their sequelae, e.g. in the procurement of inhalers and respirators. In conclusion it is stressed that the care of these patients calls for longterm planning which requires close cooperation among everyone concerned. The value of prophylactic measures is particularly emphasized.


[Biogenic amines and schizophrenia].

[Biogenic amines and schizophrenia]. Three main biogenic amine hypotheses for the origin of schizophrenia are discussed. The dopamine theory of schizophrenia postulates a pathogenetic connection between the disease and changes in the activity of dopaminergic cells in the brain. The theory is mainly based on findings on the mechanism of action of neuroleptics, on the clinical features and pharmacology of the amphetamine psychosis, and on some amphetamine effects in animals. Several results are in good agreement with the assumption of a state of hyperactivity of central dopamine neurons, whereas others, e.g. the lack of an increased dopamine turnover, are not. According to another theory, schizophrenia is caused by reversible damage to central norepinephrine cells. So far the only empirical basis for this theory is the finding that the activity of dopamine-beta-hydroxylase, a marker enzyme for noradrenaline cells, is lowered in the brains of schizophrenic patients. Thus further confirmation is required. The transmethylation hypotheses assume that hallucinogenic amine metabolites are produced in the body and lead to the appearance of schizophrenic symptoms. Whether or not the occurrence of DMPEA, presumably an oxymethylation product of the dopamine metabolism, is specific for schizophrenics is still open to question; if it is, the meaning of this finding is obscure. Current results leave open the possibility that N-dimethyltryptamine or other N-methylated hallucinogenic biogenic amine metabolites cause the disease; however, this hypothesis is hardly confirmed by positive empirical results.


[The treatment of myeloproliferative syndromes]. A review is presented of the clinical, physiopathological and therapeutic aspects of four varieties of chronic myeloproliferative syndrome: polycythemia vera, idiopathic thrombocythemia, chronic myelocytic leukemia and idiopathic myeloid metaplasia. Routine and experimental therapeutic approaches are discussed.


[The therapy of acute myelogenous leukemia]. In the last few years tremendous progress has been made in the treatment of acute myelogenous leukemia: remissions have been observed more frequently and they last longer. Present-day therapy is described. It has become so complex that induction therapy must be carried out by oncologic departments. Maintenance treatment can however be conducted by the family physician, acting in close cooperation with the oncology unit.


[Daunomycin monotherapy in acute promyelocytic leukemia]. A complete remission of 5-16 months' duration was achieved in 5 of 6 consecutive patients with acute promyelocytic leukemia treated with Daunomycin and platelet transfusions. Although 4 patients had coagulation findings suggesting disseminated intravascular coagulation, heparin was given in only one case. Heparin infusion was twice accompanied by normalization of the fibrinogen level, but had to be stopped because of severe bleeding. In the other 5 patients chemotherapy was not accompanied by increased bleeding, although 1 patient showed an initial worsening of the coagulation findings. Platelet substitution and intensive chemotherapy appear to play a more crucial role than theoretically questionalbe treatment of the plasmatic coagulation disturbance. 2 patients had central nervous system involvement, a complication previously thought to be extremely rare in acute promyelocytic leukemia.


[Dynamic tomoscopy. Experimental use of a new roentgen technic for the temporomandibular joint]. A new radiographic technique and its experimental application for the temporomandibular joint is introduced. The technique was discovered some 30 years ago, then rediscovered and developed for practical use in the late 1960's by two researchers, working entirely independently. In dynamic tomoscopy, a series of underexposed radiographs (usually 8) is produced with the X-ray source at different angles with respect to the object. Each of the resultant films bears an image of the object containing all details sharp in design and without blurring. This set of films is placed as a sandwich on a special viewer. Turning a dial on the viewer brings successively into focus the laminagraphic images of any desired plane. Shifting continually from one to another throughout the entire depth of the object creates in the mind's eye a three-dimensional radiograph, a dynamic laminagram.


[Functionally stable osteosynthesis of the mandible by means of an excentric-dynamic compression plate. Results of a follow-up of 25 cases]. The stability of internal fixation is enhanced by axial compression on the fracture ends. If internal fixation of the mandible is achieved by a compression plate at the lower border of the mandible (compression side), distraction of the fracture ends on the occlusal side occurs which has to be counteracted without damaging the roots of the teeth on the occlusal side (traction side) or without damaging the inferior alveolar nerve. From experiments on models it was seen that an acceptable solution to this problem is given by the use of the combined compression plate and tension band plate or the "Excentric Dynamic Compression Plate" (EDCP). In this paper 25 clinical cases of internal fixation of the mandible by means of the EDCP are examined and discussed. The following relevant facts were reviewed on all patients: -- kind of trauma -- age -- dentition -- localization of the fracture -- local and general additional injuries -- time of operation -- material used for internal fixation -- type of occlusal immobilisation during operation -- use of antibiotics -- skin closure -- mobilisation -- hospital stay -- duration of work disability -- complications -- scarring -- neurological disablement -- malocclusion In this paper emphasis is layed upon internal fixation by means of the EDCP. The clinical evaluation of the 25 cases clearly demonstrates that the main indication for internal fixation with the EDCP is given in fractures of the horizontal ramus of the mandible, because in this localisation the plate has to be applied beneath the inferior alveolar nerve. A further indication for internal fixation with the EDCP are fractures of the angle of the mandible. In these cases the tension band principle by means of a tension banc archbar or a tension band plate cannot be applied, because of missing teeth on the proximal fragment, or a non erupted wisdom tooth. These indications can be summarized as follows: -- In fractures of the angle of the mandible--when ever possible compression plate and tension band plate, otherwise EDCP -- In fractures of the horizontal ramus--EDCP -- In fractures of the mandibular front--DCP.


[Measurement of the oxyten partial pressure in the gingiva]. The partial pressure of oxygen (pO2) in the inflamed gingiva was measured in 24 patients before and after the application of Gingivox. The Gingivox treatment led to a significant increase in pO2 from 72.2 mm Hg to 94.6 mmHg. The arterial pO2 values of all patients, measured on the hyperaemic ear-lobe, lay within the range of normal values. The measurements were performed by means of the micro-Astrup equipment of the firm of Radiometer, Copenhagen.